As part of the release of the CQC's State of Care Report 2015-2016, we have produced a series of articles highlighting the findings and our analyses. Here, Holly Bontoft comments on the issues raised in the report about how primary, acute and social care services need to work together to prevent them being crippled.
This year's report should serve as a warning to everybody involved in the care sector; while on the whole, providers are maintaining compliant and quality services for now, all of the indicators suggest that the environment is likely to become more challenging. The financial pressures on the sector mean that the growth in nursing home bed numbers has stopped, despite the number of people over 85 (who are the most likely to need these beds) increasing by 33% since 2001. While this indicates a real problem with sustainability in the care sector itself, it also places pressure on acute and other hospital settings. Waiting for a nursing home placement was one of the biggest reasons (alongside waiting for a care package at home to be put in place) for delays in patients being discharged from hospital; according to the report, in the last year the number of 'delayed days', where patients were still in hospital despite being ready to be discharged, increased by a staggering 11%. This 'bed blocking' is bad for all concerned; the hospital bed could be used by someone else needing it, and prolonged hospital stays can also have a negative effect on someone who would be better placed in a nursing home.
In turn, 'bed blocking' affects the rest of the acute sector, including A&E. The recommended maximum bed occupancy rate for a hospital is 85%, but actual occupancy rates were above that for every quarter of 2015/16, and from January to March 2016 were at 91%. This in turn places pressure on Accident & Emergency services, when there are no available beds for patients to be transferred to, affecting the performance and ratings of acute hospitals yet further.
However, the report also highlights some potential solutions and light at the end of the tunnel. The State of Care report gives examples of increased collaboration between primary, acute and care services to deliver smoother, integrated care across a local area. One example increasingly seen in the last year is care homes based near hospitals providing a 'halfway house' between hospital and a permanent care setting, either as a rehabilitation centre or as an extension to the services provided at the hospital. From both an investor and provider perspective, this helps ensure that occupancy levels at the home remain high leading to better profitability. This is particularly pertinent for smaller operators who do not have the same economies of scale as the larger care home groups, however they may also struggle to provide the capacity needed for some hospitals. In addition, Sustainability and Transformation Plan areas are developing new approaches to health and social care services working together to ensure every patient's journey through their care is smoother, improving the patient's lifestyle and minimising the impact on service providers. Private providers must ensure that appropriate contractual arrangements are in place that provide adequate protection by establishing responsibility for transitional arrangements and clearly managing the expectations of the acute partner. There will also be a need to attract skilled professional staff to undertake assessments and care in these circumstances and attempt to define a carer structure for nurses [and others] in adult health and social care.
While good examples of collaboration throughout the sector are indicative of potential future sustainability, it is clear that further collaboration between primary, acute and care providers will be needed to ensure an already struggling system is not placed under greater strain. There is also a need for the CQC to be more flexible in its assessment and registration of new services to ensure that collaboration and creativity is not stifled on the basis it does not fit into an atypical model, while still ensuring that services meet the quality and safety requirements expected.
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