This opinion piece by COSLA Health and Social Care Spokesperson, Councillor Paul Kelly, was originally printed on 1st February 2023 in The Herald.
Yet again in recent weeks the pressures on our health and social care system have been headline news as we grapple with increased demand for health services after a pandemic and in the midst of winter.
The focus has been on the ‘front door’ of our hospitals with reports of ambulances queuing outside Accident and Emergency departments and long waits in A&E for people waiting to be seen.
It has also been widely reported that the main reason for this is delayed discharge. This is people in hospital beds who are well enough to go home but no care package is available for them.
The numbers of people who are delayed in this way have hovered around the 1800 mark for a number of months although in the past few weeks, encouragingly, we have started to see a slight fall in these numbers. In fact, if we look at the most recent statistics, we can see that almost 98 per cent of people are discharged from hospital without delay. In recent weeks between 250 to 300 people per week are discharged who were previously delayed.
Whilst we all recognise that delayed discharge is an issue it is not the whole story. We have been working with the Scottish Government, health boards and health and social care partnerships to take a whole system approach to addressing the severe pressures facing our services.
There is a role for every part of the system from primary care and GPs through to diagnostic services to prevent people needing to attend hospital in the first place through to improving the way we discharge from hospital and, of course, in the delivery of social care.
As a temporary and in-extremis measure, it was announced in January that health and social care partnerships can pay a percentage above the National Care Home Contract rate to provide interim beds for people in hospital who are fit for discharge but are waiting on a care package.
COSLA have worked closely with the Scottish Government on developing this policy recognising that hospital is not the best place for often frail elderly people and, in the short term, a more homely environment is more suitable. It will also help to free up much needed capacity in acute settings.
The Cabinet Secretary for Health announced that there are 300 care home places available. We do however need to be cautious about this availability. As others have said there are a wide range of reasons why ‘available’ care homes cannot be used including not having people to staff them to care home closures because of illness or outbreaks.
The option is there for those HSPCs – working with local partners – to use them and should be considered as another tool to address system pressures. We do, however, need to be realistic about how many beds will be available and the impact this will have. We are all very aware that this is about people who are at a very challenging time in their lives and that this is an interim measure where those who are moved into a care home can receive care in the place that is right for them.
Whilst we are in the position of having to use in-extremis measures such as this it is of crucial importance that we also look to take urgent action on supporting the care at home sector. The reasons that care packages are delayed are largely because of staffing issues and the difficulty in recruiting and retaining staff.
We are still in the position where you can earn more for work in a supermarket than you can caring for some of our most vulnerable citizens. That is not sustainable. COSLA are committed to fair work in social care and across our public services. However, fair work will require investment in the workforce in relation to pay, terms and conditions and professional development.
As it stands the Scottish Budget for 23/24 does not deliver for local government in a way that allows us to progress with the fair work agenda in any meaningful sense. Indeed COSLA has been clear that the local government settlement provides only £38m of additional money for councils to deal with significant pressures – the remainder of the increase presented by Scottish Government (£570m) is already needed for policy and other commitments.
As we continue our budget campaign, we will be making the case to the Scottish Government that if we are to avoid future winter crises like this one, ensuring that there is sufficient investment in social care will be crucial.
Councillor Paul Kelly, COSLA Health and Social Care spokesperson