Why physicians support social care solutions

Professor David Oliver is Past President of the BGS, clinical vice president of the Royal College of Physicians, a visiting Fellow at the Kings Fund, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. He tweets @mancunianmedic. This blog was originally published as part of the Health for Care Blog Series.

Why is the Royal College of Physicians (RCP) a founder member of the Health for Care coalition?

Why should a medical Royal College whose 36,000 members and fellows who are mostly doctors working in hospitals support a campaign for effective, sustainable solutions to adult social care funding and provision?

As a member of the Health for Care steering group, a jobbing NHS consultant and the RCP’s clinical vice president, I’ll explain.

Our members and fellows work in acute admission and assessment units of hospitals throughout the NHS. They work on inpatient wards and in outpatient clinics. There they see daily the effects of heavy cuts in social care provision over the past decade, even as demographic need has increased.

In our recent reports from physicians on frontline pressures, consultant and training-grade doctors have repeatedly raised concerns about bed capacity and overcrowding caused by delayed transfers from hospital. We realise that gaps in community healthcare provision are just as important as those in social care, but social care capacity and funding is a key factor.

It affects not only patient flow through hospitals and availability of acute beds but exposes stranded patients to the possible harms of hospitalisation. It can seem like the acute sector runs on a ticking stopwatch and community services on a calendar because of the mismatch in availability. We also see the human cost for patients stuck in the system and unable to access the care they need to return home, they and their families bewildered and upset by confusing funding rules and walls at the interface between health and social care.

This isn’t just our impression. Recent reports by the National Audit Office, by NHS Benchmarking and Health Watch England have produced the data and patient experiences to confirm the picture that physicians are seeing. Delays from community hospitals caused by poor social care availability also impact on use of acute beds. And England already has the fewest beds/1000 among OECD Organisation for Economic Co-operation and Development) nations.

It isn’t just problems for patients trying to leave hospital which concern our members though. We also see daily, people admitted to hospital from nursing and residential homes, which are struggling for funding and staffing at a time when their residents’ needs are ever more medically complex and support from local NHS services varies.

All too often, we see patients admitted acutely to hospital when gaps in social care provision or co-ordination with community health services are key factors. The patients we see in outpatient clinics are living with one or more long-term conditions which have broader impacts on their lives beyond the disease itself. These patients often struggle to navigate or access social care.

There are an estimated six million carers in the UK. Most are close family members and around 1.5 million are over 65, with their own physical and mental health problems – frequently caused or worsened by their caring role. Doctors spend an increasing amount of time speaking to and supporting carers, who play such an integral role in supporting our patients.

Again, physicians’ lived experience is backed by what major reports tell us. The King’s Fund and Nuffield Trust and Age UK, the Carers’ Trust and Richmond Group have all outlined the growing gaps in provision and access and the woeful lack of support for carers despite statutory rights enshrined in the Care Act.

Many of our members work outside hospitals. We host the Faculty of Public Health and several of our specialties play strong community medicine roles. As local system leaders they also have a growing stake in improving population health and wellbeing and in supporting the growing focus on integrated care. Our doctors know that adult social care has far broader roles than those so clearly visible to the NHS and especially its hospital sector.

If there isn’t the funding and workforce to deliver social care services even for people with high levels of need, then what chance is there for social care, local government and public health fulfilling their broader role in prevention, healthy communities and enabling individuals to live meaningful, connected lives and retain independence and control?

Why wouldn’t a medical Royal College support the aims of Health for Care? Social care affects our jobs, the services we work in, the patients and families we care for and the communities we live and work in. Sooner or later, it will doubtless affect us and our own families. There have been numerous chances to get this right over several governments and we have failed. Achieving Health for Care’s aims is vital to all our futures.


Professor Oliver’s commentary is a sad but accurate reflection of the state we find ourselves in the hospital setting. A recent inpatient audit revealed that nearly 50% of frail Elderly inpatients are awaiting one of these 3 things to happen:

1. Awaiting complex and large care packages

2. Awaiting placement in residential/ Nursing Home

3. Awaiting a “bed based rehab” (despite the marginal gains by D2A model)

Not surprisingly, a significant proportion of Elderly then wait in ED for hours, sometimes sitting in chairs in poor facilities! Many then get moved into surgical beds or other medical specialists wards such as cardiac units (whilst cardiac patients wait for days on Acute Medical Units).

Professor Oliver highlights the physical perils faced by stranded (indeed the term super stranded is more appropriate for the vast proportion awaiting one of the 3 mentioned above).

i support wholeheartedly, any efforts to find a solution urgently, being mindful that in the coming next decade the situation described above is only likely to worsen dramatically. 

Dr Sanjay Suman FRCP (Lon), FRCP (Ed), Consultant Geriatrician and Clinical Director, Elderly Care, Medway NHS Foundation Trust, Kent.



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