Social care is dragging down our hospitals

This winter’s crisis is being worsened by a reliance on the elderly being looked after on wards instead of at home
When Susan’s elderly mother tripped over in her nightie on the ice while trying to feed the birds, a kindly neighbour heard her plaintive sobs and called an ambulance.

It was 7am but the service arrived promptly, Dora was seen at A&E within an hour by an attentive junior doctor and Susan was told that her mother had suffered a fractured hip. She died six weeks later still languishing in hospital.

“I wish A&E had been too busy and she had been sent home,” Susan wrote to me. She might have survived. Instead she was admitted to a ward where, too disorientated and embarrassed to ask for help, she became severely dehydrated and malnourished, then picked up a vomiting virus.

Social services refused to arrange for her to come home and she slipped badly while trying to discharge herself. Soon she was “an unrecognisable skeleton with crusty eyes, bed sores and pneumonia”, Susan wrote.

This winter’s A&E crisis has variously been blamed on a chronic lack of cash for hospitals, lazy GPs, a stubborn coughing virus, too few consultants at weekends and too many drunks. For years I thought it was the GPs’ fault for failing to provide out-of-hours care and forcing invalids to trudge to A&E. But it’s clear that they are also overwhelmed. The number of GP consultations has increased by nearly 14 per cent in seven years, while A&E visits have soared by nine million a year since 2000.

The problem, in a bizarre way, may actually have been too much money going to hospitals. When the NHS budget was ringfenced after the recession, the service found that it was increasingly expected to pick up social care duties. When councils had their budgets slashed by 37 per cent, they started shutting daycare centres for the disabled and elderly and cut back on residential bills and home visits. A million fewer people now receive home help, many more can expect only 15-minute appointments from a carer, so hospitals have been expected to fill the gap. The number of days hospital patients wait on wards for suitable care-home packages has increased by 224 per cent since 2010. More than 260 care homes have shut since March with many of the residents ending up on wards. More will close this year with the introduction of the living wage pushing up costs in the sector by £2 billion.

The situation is only going to get worse with a million more people over the age of 75 within the next five years and dementia now overtaking cancer as the greatest killer.

With the living wage pushing up costs more care homes will close

A consultant friend who worked in A&E between Christmas and New Year said so many staff came in to help they were tripping over each other’s stethoscopes. The queue of patients was so long that those with ingrown toenails had given up and the drunks had sobered up; there were just real emergencies, people with suspected meningitis, sepsis and overdoses waiting in ambulances and on plastic chairs. But the problem was beds: the majority were taken by elderly patients, so they were dealing with haemorrhages in corridors and could barely admit anyone.

Having spent six weeks researching a series on social care before Christmas, it is clear to me that this is where the greatest problem lies. It costs about £250 a day to keep a patient on a ward, £150 a day in a care home and £100 a day for domiciliary care, most people’s preference. It is obvious, morally and financially, that the elderly should remain in their own homes as long as possible.

Yet more and more are ending up unnecessarily in hospital. Simon Stevens, head of NHS England, recognises this. Last month he said that social care should be “at the front of the queue” for government money because the failing system was dragging down hospitals.

A potential solution is to merge the NHS and social care budgets

A potential solution is to merge the NHS and social care budgets both locally and in Whitehall, where responsibilities are split between two departments. Integrated care is already happening in Salford and the results are promising. Nine more areas in Greater Manchester are planning to follow. There is also a GP service dedicated to the elderly that concentrates on home visits as well as a joined-up IT operation. The staff I met were fully committed to the project; they have already identified 2,000 people in hospital who could be elsewhere. 

Sir David Dalton, the chief executive of Salford Royal NHS trust, says, “It’s only just started so we are still seeing huge pressure on our hospitals but I think that gradually we are getting to a better place. Most elderly people want to be cared for in their homes not on a ward. But social care needs more money.”

Three select committee chairmen urged the prime minister last week to seek cross-party agreement on social care, and the issue is at the top of most MPs’ postbags. Before Christmas Theresa May, urged on by the chancellor Philip Hammond, gave councils the power to increase spending. But they are reticent about raising bills, particularly in deprived areas where residents are already struggling financially but few can afford their own care home bills.

When Labour last attempted to address the problem in power the Tories unfairly accused them of trying to introduce a death tax. But parliament needs to look at a different way of funding social care, either through national insurance, the introduction of care Isas or paying into social care funds. Then hospitals can focus again on healing patients and saving lives.