Complex Care Cases Contribute to Hospital Delays

September 8, 2014

The patient's hand on the bedOver the years, Homecare Providers have seen a continuous rise in the needs of our Service Users.

The number of people requiring complex care has risen to epic proportions, this has a direct impact on service delivery and responses to hospital discharges.

The latest figures from the Monthly delayed transfers of care Data, England published in August, stated that there were 4,578 patients delayed in July, of which 2,970 were acute patients (65.4 percent). This is the highest proportion reported since the collection of data began in 2010.

The main reason for NHS delays was “patients awaiting further non-acute NHS care”, accounting for 30 percent of the delays. If you drill further down into the data, acute patients delayed whilst “Awaiting a care package in own home” (and Social Care was the responsible organisation) totalled 4,877 days delayed.

4,877 days delayed in hospital whilst a care package is sourced.

Consider the financial penalties that are incurred for these delays and the money spent keeping a person medically fit for discharge, in hospital.

Then wonder why these monies are not spent on supporting hospital discharge to reduce costly delays.

In the area in which I work, no additional monies have been set for any specific community provision from Homecare services. And we are just about to go forward into winter when pressures increase.

I know the answer to a surge in demand is to recruit more staff. I hear this all the time from care brokers, as if the answer is that simple. But in order to accommodate the increasing demand for complex care, you have to have experienced care staff to deliver the service. I would not put new inexperienced carers with those requiring complex care. There has to be a lead in period for new starters, testing suitability and competency levels before you would allocate them to the most vulnerable of your service users.

There are additional skill and training requirements for staff working with people with complex care needs. Homecare staff are trained to a certain level, but specialist training for say, peg feeding, costs providers money, and even then there’s the question of which carers do you train? And where? You cannot predict where the next complex case will be required.

There must be better ways to support hospital discharge and people with more complex needs

I have two basic suggestions:

  1. Liaison between the Hospital teams and social care providers, should start as early as possible when an individual with complex care needs requires a Homecare service. Providers have more time to plan, and therefore a better chance of offering a service.
  2. We should acknowledge that care staff providing the service have increased travelling, are better trained and more experienced, yet completing the tasks required of a district nurse (whilst other colleagues are paid the same rate to make a cup of tea and have a chat).

I would suggest some money invested into a higher rate of pay for complex cases. The uplift in fee level should be directly passed onto care staff and providers should promise and prove this to commissioners. This would help improve staff retention, because let’s face it – well trained and competent carers could work in the warmth of a hospital for a higher rate of pay.

Something has to be done to reduce Hospital delays. It may be helpful to look at any trends of complex care with other providers, and formulate some analysis to share with Commissioners. The aim is for some positive solutions to meet this increasing demand and setting aside monies for community provision. In these tough economic times money should not be wasted on delays- it should be invested in a service that can alleviate the pressure.

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Rosie Robinson

Domiciliary Care Specialist


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