Eight out of 10 nurses warn that cuts to social care services are increasingly leading to more of their older patients being unnecessarily stuck in hospital, with implications for dignity and care quality.
A joint survey carried out last week by Nursing Times with the charity Age UK found 85% of respondents believed more patients had experienced delayed discharge from hospital in 2011 compared to the previous year.
The majority, 82%, said cuts to council social services had contributed to increased delayed discharge in the past year, according to the poll of nearly 200 hospital and community nurses who work closely with social care on a regular basis.
The main causes of delayed discharge identified by nurses were having to wait for a community care assessment to be undertaken, having to wait for a package of home care following the assessment and waiting for a local authority to arrange a care home place.
A reduction in social care provision was also having a negative knock on effect for community nursing teams, the survey found. For example, 51% of respondents said community nurse workloads in their area were significantly higher as a result.
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A quarter of nurses said they were rarely confident that patients received the right quantity and quality of community health and social care provision once they were discharged from hospital.
Respondents blamed this lack of confidence on understaffing in community services and poor communication between different parts of the health and social care system.
The survey was carried out to coincide with the launch of a petition by Age UK as part of its Care in Crisis campaign, demanding urgent reform of the care system for older and disabled people.
Nurses in the survey backed the campaign’s aims, with virtually all respondents saying reform was needed to either the social care funding system or the legal and assessment frameworks used for older peoples care and support.
Age UK Charity Director Michelle Mitchell said: “These findings provide an interesting snapshot into how the crisis in social care is experienced by those working at the frontline of care: nurses in both hospitals and in the community.
“These nurses report seeing social care services for older people reduced and as a result older people having to routinely stay in hospital longer than medically necessary because the support is not there for them to go home. This not only is distressing for older people but also makes no sense financially as the cost of a hospital bed is likely to be much higher than that of providing social care support.”
She added: “We urge the government to show vision by creating a system of social care that is fair and sustainable – the social care system is on the verge of collapse and needs urgent reform.”
Queen’s Nursing Institute director Rosemary Cook said the causes of delayed discharge had to be “tackled as a matter of urgency”.
She said: “We know that people would rather be in their own homes, and are usually healthier and happier there. We also need to reduce the strain on our hospitals, so that as much time and care as possible is freed up for those patients who do need to be there.”
“The problem is that the readiness of the community to receive people back for care has been going down, while the demand has been going up,” she added. “Unless we reverse the trend towards dilute skill mix and over-stretched community nursing teams, we will not be able to accelerate discharge, never mind facilitate the shift of care out of hospitals altogether.”
However, Ms Cook noted there were some good initiatives around the country. For example, in Stockport assistant practitioners were working across health and social care, and in other places she said community nursing teams were now co-located with social care teams to provide a more “seamless and patient-ready” service for discharged patients.
The government is due to publish a white paper on the future of long term care in the spring.