RCPE and BGS (Scotland) Joint Statement on extra interim care home beds.

The Royal College of Physicians of Edinburgh (RCPE) and British Geriatrics Society (BGS) Scotland have responded to the Health Secretary’s announcement earlier this week of extra funding for interim care home beds to help alleviate delayed discharge and the pressure on acute hospital beds. On Tuesday in Parliament Humza Yousaf pledged £8 million to procure around 300 additional care home beds. The most recent delayed discharge data from Public Health Scotland indicated the average number of hospital beds occupied per day due to delayed discharges was 1,950 in November, the highest since comparable data began to be collected in 2016.

Prof Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

The RCPE welcomes all efforts by the Scottish Government to ease ‘front door’ and acute ward pressures by tackling the very significant delayed discharge challenge at the ‘back door’ of hospitals. Indeed, we have been consistent in urging Ministers to focus intensely on “exit block” as we consider it key to decreasing the intense strain on acute services and we are committed to working constructively with the Scottish Government to improve the situation.

However, our College has a number of concerns about the announcement of an extra 300 interim care beds, and we are asking for further clarity and assurances from Ministers.

Firstly, we question whether the funding announced will deliver as many interim care home places as envisaged, not least as the staffing pressures in the social care sector are so extreme that it may be almost impossible for care providers to recruit the extra staff they will require.

Second, we also request assurance that patients in interim care places will be able to access adequate rehabilitation support from physiotherapists and occupational therapists. These therapy services are already stretched, and without their input the mobility and functional level of older and frailer patients can easily deteriorate.  

Finally, no patient should have to experience any “interim” placement. They should be able to move directly from hospital back to their own home, or into the care home of their first choice. Many will already have experienced multiple moves between units within our hospitals. Interim placements have existed for too long and we should aspire to end them soon. This means building a respected and valued social care workforce that can care for our older people in the years to come.

Fulfilling an aspiration to end all delayed discharges also requires accurate data. We understand that patients in interim care home places within the social care sector are not included in published delayed discharge data. We heard from the Cabinet Secretary this week that 600 beds are already used for interim placements in social care – this is in addition to those already known in the health care sector. Delayed discharges are clearly a whole system concern – we urge that published figures take account of all delays, be they in health or social care beds.

Dr Rowan Wallace, Chair of BGS Scotland, said:

The BGS welcomes the Scottish Government’s acknowledgment of the current crisis facing hospital discharge. There is a clear need to free up capacity in emergency departments and hospital wards to provide timely, safe, efficient medical care. 1,700 people are currently in hospitals across Scotland who do not need to be there but cannot access the care they need at home to be discharged. These are predominantly older people for whom extended hospital stays bring increased risk of dying in hospital, deconditioning and becoming more dependent and more confused. Increased funding is a step in the right direction but is not sufficient in isolation.

The risks associated with lengthy hospital stays for older people increase if appropriate support is not available. Older people in hospital must have access to appropriate rehabilitation before and after discharge as well as care packages available in the community. If this support is not available, older people are more likely to be re-admitted to hospital with ever-increasing health and care needs.

There are not enough healthcare professionals available to meet the complex health needs of our ageing population and services across acute, primary, community and social care are facing the same workforce challenges. We know that by investing in a multidisciplinary workforce across all care settings, we can better support older people to remain healthy and independent for longer. We urgently need a workforce strategy outlining how this will be achieved.

Whilst the release of any funding is welcomed, it has to be directed to initiatives that will enable the most effective outcomes for our older people rather than simply moving issues into other areas. Moving older people into care homes may ease pressures in the very short term but there are many more people currently in need of social care and community-based rehabilitation services than places available. We would urge Scottish Government to include experts in the care of older people in policy planning. This may feel like a new crisis but the issues are longstanding.

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