Greater investment in health and social care integration is the key to freeing up hospital beds and addressing the crisis in A&E in the capital, says London Councils.
The government has announced that councils, nationally, would receive £37 million to help with the rise in demand for home care packages over winter. However, London Councils is calling for sustainable funding of adult social care, rather than a one-off payment. Boroughs are facing a funding shortfall of £1.14 billion for adult social care by 2019/20.
Innovative schemes, in which social workers and NHS professionals work alongside each other, are effective at ensuring vulnerable people leave hospital and are safely settled back at home as soon as possible. The body, which represents all 32 London boroughs and the City of London, says initiatives in Newham, Greenwich and Richmond are having a positive impact on discharge rates, but warns they are under pressure from shrinking council budgets
Councillor Teresa O’Neill, London Councils’ Executive member for health, said: "These schemes are succeeding at a time when London councils face unprecedented funding pressures and rising demand from an aging population.
"Since the start of the decade, the proportion of people who cannot leave hospital because of social care blockages has decreased (1).
"However, it is becoming increasingly difficult to maintain social care services at their current level, and this will have a knock-on effect on other parts of the system.
"While we welcome the government’s recent announcement to provide additional funding, there must be longer term investment in health and social care to ensure that vulnerable people get the care and support they need."
In Newham, initiatives run in partnership with the borough, voluntary sector and Barts Health NHS Trust have resulted in a reduction in the number of people unable to leave Newham University Hospital because their social care support is not in place this year, compared to last year (2).
The initiatives include:
- A Home and Settle programme, in which the adult social care team works with Age UK volunteers to help people settle back at home following a hospital stay, by ensuring they have basics like bread, milk and heating.
- Social workers workings working seven days a week and co-located with hospital discharge teams.
- A hospital-based social work brokerage officer, who finds placements and sets up packages for people in need of extra support when they leave hospital, available seven days a week.
- An enhanced delivery service of equipment to support people to live at home after a spell in hospital. For urgent cases, equipment is delivered within two hours.More bed spaces outside of hospital available, including independent living flats for people.
- Cutting bureaucracy by enabling key managers to authorise placements and packages for patients so they can leave hospital earlier.
Similar initiatives are running in Greenwich and Richmond. In Richmond, the borough has set up a response and rehabilitation team at Hounslow and Richmond Community Healthcare NHS Trust. Its brokerage and community teams also work with Care UK to provide temporary placements for people stuck in hospital, but unable to go home.
While the Royal Greenwich Co-ordinated Care programme, which is an integration pioneer, is led by six integrated teams, which include nurses, physiotherapists, occupational therapists, social workers and care managers. It includes a hospital integrated discharge team which aims to allow patients to leave hospital as soon as it is safe and appropriate for them to do.
Notes to Editors:
2. There were 2.6 delayed transfers of care attributable to adult social care per 100,000 adult population in Newham in December 2014. This compares with 3.2 delayed transfers of care for the same period in 2013.
When Mrs Cartwright (name has been changed for anonymity purposes) had a tumble before Christmas, she was rushed to A&E at Newham University Hospital.
While there the 90 year old, who was receiving home-based support from Newham’s adult social care team, was found to have a mild chest infection.
Frail and unable to move very well, Mrs Cartwright needed urgent respite care.
Newham’s adult social care team were contacted immediately. A social worker, based at the hospital, turned up ten minutes after getting the call.
Mrs Cartwright was assessed and it was agreed a 24-hour package of monitoring, supervision and support would be provided.
A brokerage officer found a suitable placement within hours. After checking the patient was happy with the arrangement, Mrs Cartwright was transferred directly, without having to be admitted to hospital.
Councillor Clive Furness, the London Borough of Newham’s mayoral adviser for adults and health, said: “As a council, we work in partnership with our colleagues in Barts Health to ensure that the discharge process for residents is as swift as possible.
“Our strong relationships and effective partnerships across the health and social care system, has been instrumental in ensuring that our residents receive the support and care they need and for the high performance seen at Newham University Hospital.”