Dramatic cuts to district nursing have left older people without care at home and forced them to turn to accident and emergency departments instead, an independent report has found.
The report by consultancy firm Christie & Co, which advises business in the care sector, warned that a 44% drop in district nurses since 2010 had led to a severe loss of community care and support.
“The core message remains: a sustainable funding solution for social care is needed”
Meanwhile, it noted that overall shortages of nurses, coupled with falling numbers of applications to nursing courses and a recent fall in the number of European Union nurses coming to work in the UK in the wake of the Brexit vote, had all contributed to a “nursing crisis”.
The research, which focuses on the funding, staffing and “bed blocking” challenges affecting health and care services, included a survey of all local authorities and more than 200 care home operators.
Problems with both recruitment and retention of nurses, have led to a “vicious cycle”, where nurses leave jobs because of the pressure they are under, making it harder for those that remain and more likely they will leave too, said the report titled Adult Social Care 2017: Funding, Staffing and the Bed Blocking Challenge.
“Many nurses have left full time positions over recent years, with some joining staffing agencies and others leaving the profession. This is a trend across hospitals, care homes and within the wider community,” it said.
“One key trigger is the reduction in district and community nurses, with this leading to an increase in hospital admissions at a time when hospitals are grappling with capacity challenges,” it added.
“It is a vicious cycle with very real human consequences”
The research showed many care homes were using agency nurses to cover vacant shifts. Meanwhile, care homes were also struggling to keep hold of less qualified care assistants and domestic staff.
“Many operators report that they are competing with supermarkets like Aldi and Lidl who are actively recruiting and offer attractive pay rates,” said the report.
It said specialist care providers – such as those catering for people with learning disabilities and mental health issues – were struggling the most, as fees failed to keep pace with increased staffing costs.
It highlighted the fact many frail and older people ended up stuck in hospital due to delays in organising care placements.
However, it also suggested there was capacity to cater for such patients, even in areas that it described as “bed-blocking hotspots”.
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The report analysed data from care homes in the 10 local authorities with the highest delayed discharge rates – mainly more rural areas – and found there was spare capacity.
However, various issues were getting in way of its use, including the fact homes tended to be older, so needed investment and adaptations to ensure provision was up to scratch.
Other factors included wide variations in fees, the fact homes with capacity were often not located in the same towns as hospitals where delayed discharges were most common, and nursing shortages.
Crash in district nurse numbers driving delayed discharge
“Care homes located in more rural settings often struggle to recruit nurses and this, combined with the shortage of district and community nurses, makes it more challenging to discharge patients from hospitals into community based care settings,” said the report.
“Whilst care homes can clearly contribute in a major way to the overall solution, commissioning policies, funding and staffing remain key barriers which require a sustainable long term solution,” it stated.
This is the third year in a row Christie & Co has produced a report on issues in the care sector.
Michael Hodges, head of consultancy for care at the firm, said: “The core message remains: a sustainable funding solution for social care is needed, with ways to encourage more people into the nursing and care professions, including additional funding to enable the sector to remain competitive in terms of pay rates.”
He said both care homes and community nursing professionals had a “critically important role”, but there was a need for a more joined-up approach between the NHS and care services.
Mr Hodges also said it was vital nurses remained on the government’s Shortage Occupation List beyond the current time limit of 2019.
Pay rise above 1% ‘needed to ease nurse crisis’
Royal College of Nursing chief executive and general secretary Janet Davies said the report painted a worrying picture of the “short-sighted” approach to social care in recent years.
“The government cut local authority care budgets and older people who are no longer adequately supported at home are forced to turn to A&E. The same lack of community care means once they are in hospital they cannot easily be discharged again,” she said.
“District and community nursing staff should be there to help older people to stay well and live independently for longer,” she said. “But the loss of nearly half is one of the reasons older people aren’t being properly supported.
“It is a vicious cycle with very real human consequences,” she said. “Vulnerable people are caught between understaffed hospitals, dwindling community care and under-funded residential homes.”
This situation “cannot continue”, added Ms Davies. “The government must address it head on and invest in community care, including nursing expertise,” she said.