Almost one in four people unable to be discharged – sometimes for weeks – were trapped in hospital because they were waiting for home care, as agencies hand back contracts because staff are quitting owing to low pay, leaving 15% of jobs vacant.
A fifth of people unable to be discharged were also waiting for short-term rehabilitation and 15% were waiting for a bed in a care home, according to analysis of data obtained using freedom of information requests and public records by Nuffield Trust and the Health Foundation.
It estimated that in April this year, one in six patients were in hospital because of delayed discharge, and the discharge of patients with a hospital stay of more than three weeks was delayed by 14 days on average.
The impact of the worsening shortage of social care provision comes as homecare organisations said the outlook for recruiting staff was worse than the same time last year after 18 months of the pandemic. They warned Liz Truss’s plan to boost economic productivity will be undermined if people cannot get the care they need to get back to work.
“People are ending up in hospital for malnutrition and dehydration, problems which, even if you supported people a little bit at home, would stop,” said Jane Townson, the director of the Homecare Association.
“More providers are having to turn down work than usual and some are having to hand back people because they can’t do it.”
English councils reported earlier this year that the number of hours of home care that could not be delivered owing to capacity constraints rose to 2.2m in the spring, a huge leap from less than 290,000 hours for a similar period in 2021.
The Nuffield Trust thinktank also warned that people get more ill if they languish in hospital, further exacerbating the pressure on social care, as delayed discharges increased by 57% in the 12 months from April 2021 to April 2022.
“Delayed discharges are a lose-lose situation, creating congestion in hospitals and distress for patients, increasing infection risk and muscle deterioration from being stuck in a hospital bed,” said Sarah Scobie, Nuffield Trust deputy director of research.
“An effective homecare sector would reduce these unwanted delays, but it faces an uphill battle.”
Last week, the government announced £500m to boost social care places to tackle the problem, but Scobie described this as “a drop in the ocean when set against the perilous situation with care outside hospitals”.
There has been an increase in demand for home care, in part because people not being treated in hospitals because of waiting lists are getting ill and need help at home. Seventy per cent of homecare packages are funded by local authorities, but they have not been able to increase funding enough to stop care workers switching to better-paid work in retail and hospitality.
Homecare workers drive from job to job and while NHS staff are paid 56p a mile fuel allowance, homecarers typically get half that, which means they have been worse hit by soaring prices at the pumps.
The Department of Health and Social Care said the £500m fund would “speed up the safe discharge of patients from hospital and … recruit and retain more care workers”. It said its “workforce development fund” is improving staff retention, and highlighted a £15m spend to boost international recruitment.