Social care recruitment concerns raised over plan to alleviate bed blocking

Health experts have cautiously welcomed the Scottish Government’s plan to free up hospital beds, but voiced fears it may be “almost impossible” to recruit the extra social care staff required.

The Royal College of Physicians of Edinburgh (RCPE) and British Geriatric Society (BGS) Scotland issued a joint response to Health Secretary Humza Yousaf’s announcement earlier this week of extra funding to provide more interim care home beds.

The £8 million pledged to procure about 300 additional beds aims to alleviate “bed blocking” – the long-term occupation of hospital beds, primarily by elderly people, due to a shortage of suitable care elsewhere.

Recent Public Health Scotland data shows 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.

Andrew Elder, president of the RCPE, said there remains “a number of concerns” about the announcement, including around the need for more staff.

“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,” he said.

“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.

“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.”

Professor Elder said the Scottish Government also needs to provide more assurance that patients in interim care places will be able to access adequate rehabilitation support from physiotherapists and occupational therapists.

He said interim placements have “existed for too long”, and measures should be put in place to end them, such as “building a respected and valued social care workforce that can care for our older people in the years to come”.

He added: “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.

“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.”

Rowan Wallace, chair of BGS Scotland, welcomed the extra funding, but said it may only assist with bed blocking issues in the short-term.

“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,” Dr Wallace said.

“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.”

Dr Wallace also commented on staffing concerns, adding: “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.”

A Scottish Government spokesperson said: “Patients should be looked after where their needs can best be met.

“We have identified that around 300 beds are available in care homes for interim use. This is in addition to approximately 600 interim beds which are already being utilised.

“We are working with Cosla and care homes to make use of these additional beds as swiftly as possible so anyone ready to leave hospital can do so promptly and safely. Hospitals will follow Public Health Scotland Covid guidance including testing anyone discharged before admitting them to a care home for older people.

“We are making available funding of £8 million so that Health and Social Care Partnerships can address local need and we will work closely with partners across the NHS, Health and Social Care Partnerships and local authorities to ensure the impact of that funding.”