Hospital discharges limit home care in England, say councils

Local government leaders are warning that vulnerable people are losing access to basic care at home due to a wave of rapid hospital discharges that are draining resources.

Despite cross-party support for more early care at home, City Hall officials are having to free up resources for people with more complex needs, many of whom have been discharged early from hospital as part of efforts to reduce backlogs in the NHS.

This means thousands of others are “at risk of missing out (on care) or having their needs increase”, the Association of Directors of Adult Social Services in England (Adass) warned after its annual survey of 153 social care directors in England.

It found that only one in ten directors were completely confident that their budgets would meet their legal obligations, compared to just over a third before the Covid pandemic.

Jane Townson, a social care leader and director of the Homecare Association, compared the pressures of the current situation to “juggling burning torches”.

Spending aimed at preventing people’s conditions from deteriorating was cut by £121m last year. As the complexity of cases increased, councils overspent by £586m – the highest level in at least a decade, leading to raids on decreasing council reserves.

The findings were “untenable and worrying”, said Melanie Williams, chair of Adass and director of adult social care at Nottinghamshire County Council.

“Rather than focusing on investing in hospitals and freeing up beds, the new government should focus on investing in more social care, supporting unpaid carers and providing healthcare in our local communities to prevent people reaching crisis point and ending up in hospital in the first place,” she said.

Helen Wildbore, director of Care Rights UK, an organisation representing care recipients and their families, said behind the statistics “are people whose lives are being destroyed by humiliatingly stretched budgets and a focus on systems rather than people”.

“This cannot continue,” she said. “There are many urgent priorities for the new government, but ensuring dignity and respect for older people and people with disabilities in the most vulnerable situations must be at the top of the list.”

However, there was also good news: the number of people waiting for care or an assessment in the six months to 31 March 2024 fell by 11% to 418,029.

The Labour Party has pledged to establish a national health service, create closer partnerships between hospitals and the health sector to manage hospital discharges and explore how to increase the role of health providers in primary health care and monitoring.

But it has made no funding announcements and stressed on Monday that it is in the early stages of a new government. Last week, Health Minister Wes Streeting said he would shift money from hospitals to GPs to “deliver more care closer to people’s homes”.

The increasing complexity of the needs of people discharged from hospital and the growing demand for ‘ambidextrous care’ are key concerns. There was a 7.5% increase in the number of people requiring visits from two or more care providers over the past year. The average number of hours of home care provided to each person by local authorities rose from 697 in 2022 to 750 in 2024, leading to a rise in home care spending of just over a quarter over that period.

Martin Tett, leader of Buckinghamshire County Council and spokesperson for the County Councils Network on adult social care, said the survey of English councils “illustrates the extent to which the social care system is under pressure, with more people needing more complex care and local authorities overspending as a result.

“Ministers should establish sustainable and long-term financing for municipalities, distributed according to local needs.”

A Department of Health and Social Care spokesperson said: “We are determined to tackle head-on the significant challenges facing social care. We will deliver a far-reaching programme of reform to create a national care service and ensure everyone gets the care they need.”