Policy hot seat

How effective has the hospital discharge programme been at improving capacity in the social care sector and increasing the hospital discharge rate?

The extra investment was undoubtedly needed, but the money hasn’t been as effective as the government would have hoped for. That’s why additional funding has subsequently been required. But it’s naïve to believe short-term injections of funding alone are the solution to the problem. Instead, much more needs to be done to achieve parity of esteem, opportunity, and pay between a career in the social care sector and that of the NHS.

Also, integrated care pathways aren’t as developed as they should be. There needs to be more streamlining both in terms of funding, but also the discharge process. The communication and assessment between health and social care is still too disjointed.

Do you believe slow hospital discharge rates are primarily because of shortcomings in the social care or secondary care sector?

Forty per cent of hospital discharges are delayed awaiting a social care package, the remainder are down to other factors. We need to get a better handle on what drives these ‘other’ factors.

But, and in terms of those waiting to access social care, I know from my work in Parliament and in my constituency that these problems aren’t unique to NHS England.

Access to social care in rural areas is a particular challenge and is often a symptom of the chronic workforce crisis facing the sector. Care providers, including those in my constituency, often tell me how they invest significant resources recruiting, training and trying to retain carers only to find that they leave the sector in favour of other higher-paid jobs. Tackling the social care recruitment crisis is a key issue.

Will improved intermediate care, such as community health services, and increased ‘virtual ward’ capacity free up hospital capacity?

Community health services have an important role to play. But they present another workforce issue. Is the manpower required to provide these services going to drain staff away from areas such as primary care, social care and the NHS? How will training be delivered? Effective long-term workforce planning is required.

But we also need to address barriers preventing people from accessing primary care services. Improved access to primary and community care will improve early intervention and alleviate demand for secondary care.

Diagnostic centres and mental health hubs based in the community could play a valuable role in alleviating pressure on hospitals and mental health services, but, again, it’s about having appropriately trained staff to service them.

Technology is another important part of the jigsaw. Robotics, patient screening, virtual wards etc. Technology can carry some of the load. The complete digital integration of community health must be a priority.

Bureaucracy in the NHS has often stifled innovation. Covid demonstrated that by cutting out this red tape the results can be transformative. We must nurture digital innovation in the health service, but doctors and nurses and other experts need to be involved in the development process.