Predictions in care home meltdown in London becomes reality

Commenting on the damning National Audit Office report into delayed discharge, "Ensuring the effective discharge of older patients from NHS acute hospitals", published today, which found that:

• the main reason for older people not being discharged from hospital is that demand for care beds is exceeding supply

• the proposed fines system will lead to perverse incentives on Local Authorities and Trusts to put people in the most readily available, rather than the most appropriate, type of care

Liberal Democrat Spokesman on Older People Paul Burstow MP said:

"It's now official. For thousands of London's most vulnerable older people, the predictions of a meltdown in the care home sector have become a terrifying reality.

"The collapse in the number of care homes is denying vulnerable older people from getting the right care, in the right place, at the right time.

"This report shows that Ministers' obsession with targets is perverting clinical priorities. The fines system that Alan Milburn is fanatically pursuing has received yet another nail in its coffin.

"With dire warnings about the end of preventative care and an effective endorsement of crisis management, older people will in future be forced into hospital before they stand a chance of getting one of the scarce care beds that are left.

"Until the Department of Health listens to those who work within the health and social care system, more older people will be treated like unwanted packages in a macabre game of pass the parcel.

"It is time for the Delayed Discharge Bill to be scrapped. Long term investment in our creaking care system - such as free personal care for the elderly - must be put in, so that older people are treated with dignity and not discrimination."

ENDS

Notes to Editors.

On page 35 para 4.4:-

"In some parts of the country, there are severe capacity problems in residential and nursing care leading to delays in patient discharge For London and the South East as a whole, demand exceeds supply. There is a particular shortage of beds affordable to councils. Occupants of homes in the South East are much more likely to be self-funders (paying fees from their own resources) and to be able to pay more than council clients. In addition, a severe shortage of care homes in the capital means that London boroughs seek to place their clients outside the capital. The revenue support grant for London boroughs reflects the higher costs of care in the capital, and this allows these boroughs to pay higher care home fees than local authorities in popular locations in the rest of the South East, especially on the border with London. This results in delayed discharges in areas with supply problems (Figure 23 overleaf)."

Page 33 of the report warns of the consequences of the proposed fines system that is due to be discussed in the House of Lords on the 17th and 18th February 2003. It said:

"3.22 However, on the basis of concerns raised by numerous bodies that we spoke to in England, the department should be alert to possible undesirable outcomes such as:

• Perpetuating historical funding imbalances between the acute and social care sectors, and reducing funds available for the commissioning of older people's services;

• Creating perverse incentives for social services departments to place people in the most readily available, rather than the most appropriate, type of care;

• Causing patients in acute care to be prioritised over those in non-acute;

• And penalising good-quality social services departments for situations beyond their control."

Table 22 on Page 36 shows that for the first time, demand is exceeding the recommended bed occupancy rate of 90% for residential and nursing home supply across 6 out of 9 areas (North West, West Midlands, Eastern, London and the South East) and over the whole of England.

This is agreed to be the 'gridlock' point for the care sector. In London, the South East and the West Midlands demand exceeds supply leading to either more bed blocking, long waiting lists for care homes, or older people being discharged into inappropriate settings. In effect, the system has collapsed.

On page 35 para 4.4:-

"In some parts of the country, there are severe capacity problems in residential and nursing care leading to delays in patient discharge For London and the South East as a whole, demand exceeds supply. There is a particular shortage of beds affordable to councils. Occupants of homes in the South East are much more likely to be self-funders (paying fees from their own resources) and to be able to pay more than council clients. In addition, a severe shortage of care homes in the capital means that London boroughs seek to place their clients outside the capital. The revenue support grant for London boroughs reflects the higher costs of care in the capital, and this allows these boroughs to pay higher care home fees than local authorities in popular locations in the rest of the South East, especially on the border with London. This results in delayed discharges in areas with supply problems (Figure 23 overleaf)."