College raises concerns over social care workforce shortage

The Royal College of Physicians of Edinburgh (RCPE) has said that the social care workforce shortage could have a dramatic impact on patient services in NHS hospitals across Scotland.

RCPE is concerned that understaffing in social care is causing – and will continue to cause – delays in returning patients to the community after a hospital stay – otherwise known as “delayed discharges”.

While RCPE acknowledges the need for service redesign and healthcare integration, they are calling on the Scottish Government to prioritise the health and care workforce as a matter of urgency.

A recent Audit Scotland report concluded that the 200,000-strong care workforce “…is under immense pressure and feels undervalued”. It cites low pay and poor conditions of employment as key causes of a high vacancy rate and problems recruiting and retaining care staff.

According to Public Health Scotland, in November 2021, there were 46,894 days spent in hospital by people whose discharge was delayed. This represents an increase of 40% compared with the number of delayed days in November 2020.

Longer stays in hospital can increase a patient’s chances of readmission to hospital, can negatively impact their health and their mood, and may increase their risk of infection. These factors can present particular challenges to treating elderly or frail patients. RCPE is clear that delayed discharges may put additional pressure on overstretched hospital services during the COVID-19 pandemic.

Health and social care working together as early as possible in the care pathway is essential for patients requiring additional support at home or awaiting residential or nursing home care. This can only be achieved with adequate numbers of health and care staff, and they must be valued and rewarded for the essential work they do.

Professor Andrew Elder, president of the College said:

The College welcomes the publication of the Audit Scotland report and supports the conclusion that increased numbers of appropriately trained staff are required across the social care sector.

Health and social care systems cannot be viewed in isolation: suboptimal performance in one leads to suboptimal performance in the other. Given that fact, the capacity pressures we are currently seeing in NHS hospitals in Scotland cannot be solved by measures – which we welcome - to address hospital staffing or resourcing alone.

Similarly, the redesign, restructuring or integration of health and social care, which we also support, cannot in isolation deliver care of the standard our patients require and deserve, without the skilled workforce being increased.

Our population is ageing; the prevalence of dementia and multimorbidity is increasing. Patients of all ages who require the care of another person to support their basic activities of daily living must be able to access that care swiftly and easily.

We call on the Scottish Government to urgently prioritise workforce over service redesign or integration for the moment, and move even more quickly to build an appropriately trained social care workforce.

It is only by doing this that we can hope to build sustainable systems that minimise unnecessary admissions to hospital, help people to get home from hospital without unnecessary delay, and avoid our “winter pressures” lasting all the year round.