Reported by the BBC: 21 March 2017: An online system is aiming to reduce *delayed discharge from hospital by allowing real time bookings of care home beds. Bed Finder is being used by Hertfordshire County Council and is thought to be the first system of its kind to streamline referral processes and make searching for and booking beds more efficient.
One of the biggest issues facing hospitals across the UK is finding places for usually older patients who are medically fit, but need further care packages - so-called 'bed blockers'.
"We spend a lot of times on the telephone trying to establish where the vacancies are in homes," said Christine Hartley, from Hertfordshire County Council.
"Phoning round the homes and getting an answer, I'd perhaps only get two answers [out of 10 or more] and yet I'd spend all that time on the phone."
The system, developed by the OLM Group, is said to have cut bed booking times by up to 50%.
*The BGS objects to the term 'bed blocking' and the implication that the patient is somehow at fault. It uses the term 'delayed discharge' or 'delayed transfer' which reflects more accurately, flaws in the system which prevent medically fit patients from being discharged safely.
Submission from the British Geriatrics Society
[Download the submission in pdf format]
1. The British Geriatrics Society (BGS) is the professional body of specialists in the healthcare of older people in the United Kingdom. Our membership is drawn from doctors practising geriatric medicine including consultants, doctors in training and general practitioners, nurses, allied health professionals, researchers and scientists with a particular interest in the care of older people and the promotion of better health in old age. BGS has 3,500 members who work across England, Scotland, Wales and Northern Ireland. In Wales our members play a key role in acute hospitals and the community in delivering effective healthcare for older people.
2. BGS welcomes the opportunity to present this written submission to the Committee’s Inquiry. We have noted the Committee’s specific interest in evidence for the scale and causes of loneliness and isolation, and its impact on health and social care services, together with evidence of what works in addressing the issues. Our submission focuses on the loneliness and isolation experienced by older people in Wales.
Research funded by Bristol City Council and carried out by the University of the West of England (UWE Bristol) in collaboration with local groups found that BME (Black and other Minority Ethnic) community leaders are increasingly aware of how dementia affects many people from BME communities. The research found that community led VCSOs (Voluntary and Community Sector Organisations) are open to training and partnership working to enable them to provide better service to their members.
Bristol has a culturally diverse and ageing population. People from many BME communities in the UK are disproportionately affected by risk factors for dementia, including diabetes and cardio-vascular disease as well as being affected by a range of health inequalities. The number of people living with dementia is expected to increase significantly over the next 30 years, with a faster rate of increase amongst people of BME origins. A seven-fold increase in dementia cases is predicted for people of BME origins in comparison with a two-fold increase amongst people of white UK origins.
Reported in The Guardian 10 March 2017: The care home industry has called on the government to ensure that £2bn of funding earmarked for social care makes its way to frontline services rather than getting stuck within local authorities.
Senior figures in the care home industry claim that previous attempts to pump money into social care have failed and are concerned the same will happen again.Last year councils were given the power to increase council tax through a precept if the extra funds went to social care providers. However, industry sources claim that while more than 90% of councils did increase council tax, only half passed on the funds.
Tim Hammond, the chief executive of Four Seasons, said: “It’s good news that the chancellor has committed additional funding to ease pressures on a social care system that is at tipping point, with £1bn to be available in 2017-18, allowing local authorities to act now to commission care packages. We look forward to this being factored into discussions with commissioners [such as local authorities].
Reported by careinfo.org (March 2017): The National Audit Office has warned that progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. As a result, the Government’s plan for integrated health and social care services across England by 2020 is at significant risk.
In the face of increased demand for care and constrained finances, while the Better Care Fund, the principal integration initiative, has improved joint working, it has not yet achieved its potential. The Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3bn spent through the Fund in 2015-16. Nationally, the Fund did not achieve its principal financial and service targets over 2015-16, its first year.
Planned reductions in rates of emergency admissions were not achieved, nor did the Fund achieve the planned savings of £511 million. Compared with 2014-15, emergency admissions increased by 87,000 against a planned reduction of 106,000, costing £311 million more than planned. Furthermore, days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146 million more than planned.
BGS, London 9 March 2017: The British Geriatrics Society welcomes yesterday’s announcement in the Chancellor’s Budget Statement that the Government will be publishing a Green Paper this year on the future financing of social care. We have been calling for a lasting solution to the current crisis and are pleased that there is a clear recognition of the need for a sustainable and strategic approach to the funding of care for older people.
We also welcome the announcement of additional funding for social care in England which is urgently needed. However, we continue to be concerned about the capacity to deliver adequate social care support for older people within the current financial framework.
In response to the budget statement, Dr Eileen Burns, President of the British Geriatrics Society and a Clinical Director in Leeds Teaching Hospitals NHS Trust, commented:
“It is encouraging that the urgent need to address the crisis in social care has been recognised in this latest budget. BGS members see the effects every day when older people’s discharge from hospital is delayed because of difficulties in accessing social care, and the likelihood of presenting at A&E or being re-admitted is increased.
We believe that the inter-dependent nature of health and social care services means that the long-term sustainability of the NHS can only be secured if there is sufficient investment in both health and social care. At present many older people living with frailty, dementia and complex long-term conditions are experiencing poorer health outcomes because social care has not kept pace with the increase in demand. We look forward to publication of the Green Paper later this year”
CQC (2 March 2017): The Care Quality Commission (CQC) has published a report on the findings from its first round of acute and specialist hospital trust inspections.
The report shows variation in the quality of hospital services – but also highlights those hospital trusts that have been able to make practical changes to the way they deliver care and are seeing improvements to patient care as a result.
The overarching message from the CQC inspections is that effective leadership delivers high-quality care. In hospitals rated good or outstanding, the trust boards had worked hard to create a culture where staff felt valued and empowered to suggest improvements and question poor practice. Where the culture was based around the needs and safety of patients, staff at all levels understood their role in making sure that patients were always put first.
• ‘Patients are dying as a result of not accessing specialist care, as the hospitals are jam-full’
• ‘My hospital has 99 delayed discharges and 60 medical outliers in surgical beds’
• ‘…we are taking the least risky, least unsatisfactory of two equally unsatisfactory options…’
• ‘One patient spent so long waiting for social care that her family were bringing in IKEA furniture to make her hospital bed area ‘more homely’’
• ‘…things I never expected to see…the corridor folder…’
• ‘We started the day 73 beds down…’
A new RCP publication collates the experiences of doctors on the NHS frontline over the last couple of months.
Substance misuse is on the rise in older adults due to an ageing population and ‘the baby boomers’9 approaching older adulthood. It is estimated that substance misuse will double between 2001 and 2020 in adults over 65 and is related to increased mortality and morbidity. 1, 3
Substances misuse ranges from the harmful use of alcohol, tobacco, and illicit drugs to prescribed and over the counter medication. Older people are more vulnerable to harmful effects of substance misuse due to the physiological changes associated with ageing, polypharmacy and co-morbid illnesses as well as the direct impact on physical health due to poor diet, isolation and poverty.1 Healthcare professionals may be uncomfortable asking about substance misuse in older people and the information may not be disclosed by patients or carers but certain symptoms should trigger screening for substance misuse especially as they can be easily attributed to ageing or an early dementia1 (see box 1). Risk factors for substance misuse can include loneliness, retirement, isolation, bereavement or an underlying depression, anxiety or cognitive disorder.
Message from Dr Martin Vernon, National Clinical Director for Older People: The new GP contract for 2017/18 was announced on Tuesday (see report below). It withdraws the avoiding unplanned admissions enhanced service and aims to ‘put a mainstream focus’ on older people living with frailty through a requirement for routine frailty identification for people aged 65 and over using a validated tool (for example, the electronic Frailty Index) to proactively identify and support older people living with frailty. For people with severe frailty (around 3% of over 65s) this will include a clinical review (medicines review, falls assessment and other clinically relevant interventions) and encouraging use of the additional information in the summary care record to promote safe, joined up care across different settings. We hope you agree this is a step forward in the journey towards more proactive, person-centred care for older people living with frailty.
Our next step is developing the guidance that helps practices introduce the contractual requirements smoothly, as well supporting those practices that want to go further to take greater advantage of the opportunity that routine frailty identification offers for improved prevention and better care.
We would value your continued support and guidance to help inform this and, in the meantime, if you have any queries or would like any further information please contact