Welcome to part 3 of the myHSN op-ed by our co-founder Dr Andrew Stein. Read on to find out what the NHS needs to change to improve the care you receive.
3. Social care
We can’t discuss the NHS without addressing the role of councils in social care, which has a huge effect on hospitals in particular.
The term ‘Department of Health and Social Care’ is a misnomer. It’s actually the Department for Levelling Up, Housing and Communities, i.e. local government and councils who are in charge of social care. This is a huge problem, because it has a smaller budget, different processes, systems, loyalties and traditions – different everything, essentially.
If social care were under the umbrella of the NHS, the 25% of patients who are stuck in hospital – labelled ‘medically fit for discharge’ and ‘waiting for social’ – wouldn’t be there. We call these ‘complex’ patients, but they are just as important as other patients whose discharge is straightforward. Discharging complex patients in good time would free up resources to deal with the six million patients on waiting lists for operations.
But who are these patients? They are often vulnerable or elderly patients awaiting care arrangements such as a place in a nursing home or carers. It is the council’s role to provide these arrangements rather than the NHS.
However, as we all know, local councils are strapped for cash. Crucially, unlike the NHS their funding is not linked to population growth and councils are required to stay within budget year on year. The NHS budget has an advantage here because it doesn’t legally need to stay within budget. Most hospitals and the clinical commissioning groups that fund them are therefore effectively bankrupt every year, and lack of financial rigour leads to sloppy accounting and inefficiency.
The harsh and unpopular reality is that the public end up having to contribute significantly to long term care for their family members, sometimes even selling their houses to pay for care home fees.
Another issue is the difficulty of discharging patients into social care at the weekend. Ironically, carers still work in nursing homes at the weekend and are available, but these patients can’t be discharged, which contributes to hospital logjams and lengthens waiting lists. More ironically, the reason that care homes don’t take patients at the weekends is because the NHS essentially doesn’t work at the weekend.
An example
Mary is a frail elderly woman who lives in a nursing home. One day she fractures her femur and is sent to hospital, where she takes priority over a planned operation.
Four weeks later, she’s ready to go home but still stuck in hospital, costing the NHS £400 per day. In fact, there’s actually no incentive for the nursing home to take her back at all. Why? Because the nursing home is paid for the bed whether Mary is there or not. If everyone’s getting paid, there’s no reason to push for Mary to come back to the home.
If Mary has been transferred to a larger hospital for the operation, she could now be in a different council ward – again, the care home will have no incentive to take her back, and the current hospital has no links to the original council. Mary is stuck in the system.
Solution: move social care into the NHS and run it seven days a week
The budget for healthcare is over £150 billion a year, versus about £30 billion for local government. This reflects the government’s priorities when it comes to social care. The state should pay for all social care via the NHS, if necessary through general taxation, so that people don’t have to make huge sacrifices in order to get proper care for their relatives.
How (would this affect you?)
This is already a long article so we’ll keep it brief: a joined-up health and social care system will get you or your loved one back home quicker from hospital. It would aim to free up beds, and in turn enable more elective care and reduce waiting lists.
This would likely have a knock-on effect to the amount of tax paid and would effectively increase how much tax you pay. However, looking at the bigger picture, this would prevent the need for many to resort to private healthcare to be seen quicker. Therefore, this would theoretically cost us all less down the line, whilst guaranteeing quicker discharges and lower operation waiting times.
Join us for part 4 tomorrow!
As always, best wishes from myHSN!
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