Rachel Thwaites, Research Fellow (HSMC)

ResPublica launched Care After Cure: Creating a Fast Track Pathway from Hospitals to Homes on 1 March.  In the report they outline the increasing strain the NHS is under, particularly its acute hospitals.  Emphasising the complex and increasing needs of older people in the health ‘ecosystem’, the authors aim to provide a solution to delayed discharge: replacing the existing Better Care Fund with a ‘Fast Track Discharge Fund’. 

This new fund, they argue, would help combat the £2 billion spent on caring for patients who are medically fit to leave hospital and reduce the strain on the precious resource that is hospital beds.  They claim it will reduce costs, as residential care is cheaper than acute hospital care.  Furthermore, they argue that moving patients who do not need acute care into step-down services would provide a greater role for residential care homes in the overall health and social care system, and saving acute hospital care costs.

At the launch event it was clear that the report’s authors were keen to provide quick and practical solutions to the problem of delayed discharge and the limitations of the Better Care Fund. Despite this caveat though, queries remain over this new Fund, including: how it would be saved from the same limitations as the Better Care Fund; how clinical commissioning groups (CCGs) would administer it effectively and invest in local residential care to enable this sector to cope with this new role; and whether intended savings would really come to pass, especially in the long-term.

Another challenge is the lack of engagement with older people themselves in relation to whether they would value this greater use of residential home care.  In our current work at the Heath Services Management Centre (HSMC) on preventable admissions, we have been concerned at the almost total lack of engagement with older people and their families in research on this issue, and the failure to investigate what they really need to help them stay out of hospital.  The ResPublica report focuses on the need to reduce delayed discharge and associated costs – what for me is missing however is older people themselves.  In a climate of ‘nothing about me without me’ and increasing personalised care, the rather detached nature of this report is striking. 

Patient flow is, of course, a highly important issue, but there is a vital need to attend to the impact of transitions in care on older people themselves.  Previous research from the University of Birmingham has shown how confusing, anxiety-provoking, and difficult older people can find transitions to step-down care when not consulted about the process of leaving hospital, where they will move to, and what the benefits of such care might be, with older people tending to feel that they have to be passive in the face of a bewildering system. 

The wider needs and experience of the older person must be taken into account when setting up any fund, plan, or ‘solution’, especially where disruption and anxiety are likely to cause deterioration in an older person’s cognitive and physical capacity along with a sense of lost well-being and personhood.

Whilst the desire for quick solutions to a rise in emergency admissions crisis is understandable, the key to ensuring that the right patients are being cared for in the right place at the right time calls for more of a focus on upstream prevention,  with older people themselves as key partners in discussion about what this might entail.  This is the approach to understanding prevention which our current study is taking. We are finding that this upstream work is vital to looking after older people with complex needs and to ensuring patient flow both into and out of hospitals is both appropriate and smooth.

Rachel Thwaites, Research Fellow (HSMC) E: