As the Scottish Government announces funding for more patients to be discharged from hospitals into care homes, a leading figure in the social care sector has warned that Scottish care homes lack capacity for managing extra workload.
Dr Donald Macaskill, chief executive of Scottish Care, a membership organisation for social care providers, told Nursing in Practice that care homes would not be able to meet the additional demand without additional staff.
This comes as Nicola Sturgeon, First Minister of Scotland, announced yesterday that ‘immediate extra funding’ would be made available for health boards to buy spare beds in care homes for hospital patients awaiting social care.
Ms Sturgeon said in a briefing that Scotland’s hospitals were ‘almost completely full’, with wards hitting 95% occupancy, well above the recommended safe threshold of 85%. It is estimated that there are 1,700 patients in hospitals who are medically fit to discharge.
However, Dr Macaskill warned that the Government’s plan to discharge more patients into care homes would not be sustainable ‘without the staff’.
‘The physical availability of a bed in a location, whether that’s in a care home or a hotel, doesn’t really matter,’ said Dr Macaskill, ‘it’s the fact that you are able to safely staff the support and care required by the person in that bed’.
‘That’s the critical issue and at the moment, while there may be physical beds [in care homes], they’re not being used and can’t be used due to to the non-availability of staff.’
Currently, staffing levels in care homes are being severely impacted by outbreaks of influenza and Covid within care home staff. Dr Macaskill said that the diseases have ‘come back with a vengeance this winter’, restricting care homes’ ability to take hospital discharges.
Anecdotal evidence collected by Scottish Care suggests that current staff absence due to illness is approximately 6-8% in most care homes, however, individual homes can have much higher rates. One provider who spoke with Scottish Care reported that 60% of their staff were absent due to illness, he said.
Dr Macaskill also warned that while social care nursing was already ‘significantly short of staff’, the problems facing the social care workforce have worsened in recent years.
Surveys of Scottish Care member organisations found that 75-80% of care providers had a nursing vacancy or shortage, the organisation said. Before the pandemic this number was only 30% of members.
An increasing draw of staff into agency roles and into the NHS itself is exacerbating staffing issues. Meanwhile, Brexit combined with a ‘toxic environment’ and a ‘lack of flexible migration policy’ has lead to large losses in valuable and highly skilled staff, said Dr Macaskill.
Care homes are increasingly being called on to fill in as a step-down service between hospitals and the community where patients would be looked after in their own homes.
However, by using care homes acting as a interim care provider the Government is only ‘pushing the problem down the calendar by six to 12 weeks’ says Dr Macaskill.
‘It’s not a long term solution, it’s a short term response to a long term problem which is avoiding unnecessary admission in the first place and ensuring that the social care system is sufficiently robust to enable appropriate, timely, and safe discharge.’
A representative for the Scottish Government said: ‘It is critical that people are cared for in the right setting and that vital hospital beds are there for those who need them. That’s why we are working tirelessly with health and social care partnerships, with significant additional funding made available, to ensure patients can access the right care at home or in a community setting as soon as they are well enough.
As an additional and exceptional measure – COSLA and the Scottish Government have worked with partners across the care home sector to identify additional, interim, spaces within care homes to help provide additional pathways for people to be discharged from hospital in a timely and safe fashion.
‘To support Health and Social Care partnerships secure the extra provision we are making available an additional 25% above the national care home contract rate. This is an in-extremis, time-limited measure that is required to help us with the current capacity issues we face. Funding of at least £8 million will be provided on a non-recurring basis within the 2022-23 financial year.’