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Better Care Fund: time to change?

11/01/2022

Bed blocking costs the NHS £6m/day! How can we get people home safely, more effectively?


New figures from the NHS highlight that currently 10+% of hospital beds are occupied by people who have been declared fit for discharge, but who are unable to go home because they need community equipment or a home adaptation. They need non-clinical support. They need housing support.

According to representatives of the key bodies- the Better Care Fund and Disabled Facilities Grant (DFG), it is not a case of lack of funding. It is a case of HOW that funding is allocated by the local authority (the council), and, to a lesser extent, people’s awareness of what help is available. 

How it works now….

To date, 92% of local authorities have elected to opt for Regulatory Reform Orders.

These Orders give the local authority the discretion to use DFG funding for wider purposes. They enable funding to be used in a targeted way to both accelerate timely discharge from hospital, and, importantly, to prevent avoidable admissions.

Evidential examples include allocating funds to cover the cost of providing an Occupational Therapist to work in partnership with the local NHS Trust, to fund an effective integrated community equipment & support service or cleaning and/or decluttering a person’s home.

There is failure to look beyond WHAT and HOW that is delivered.

There has been failure to consider the impact on all involved including other members of the household. There has been a failure to appreciate the very essence of the Better Care Fund- to deliver a PERSON- centred approach to improving outcomes, experiences and overall wellbeing.

That is despite a strategy being in place in almost all local authorities across the country, via Regulatory Reform Orders (RROs).

People may have to stay in hospital longer than necessary

As a perspective, each night someone spends in hospital costs up to £500/bed. 

!0% of the NHS bed stock i.e. 12,490  (https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/)  is blocked, representing a daily cost of more than £6million (£6,245,150) spent on people who are otherwise fit to return home.

Compounding the problem are the conflicts of aim and perception. The DFG is about housing, specifically enabling people to remain in their home. The NHS Trusts/hospitals view the non-clinical support to facilitate someone’s ability to go home as social care. Occupational Therapy is about helping people stay well at home for longer, preventing hospital admission, giving people choice and control, reducing the need for care, and helping them have access to the wider community(Royal College of Occupational Therapy, Adaptations without Delay)

a new model is needed

As mentioned above, there are already some forward-thinking Trusts and Councils who are taking steps to improve service delivery.

But does it need to go wider? Should we be taking a holistic approach, that addresses the home environment too?

If we have more appropriate housing, that in itself can reduce the need for adaptations.

Consider:

  • According to the English Housing Survey, 25% of existing homes are unadaptable
  • Some 20% of us- 13.5million people- live in flats
  • 80% of disabled people, that’s more than 11million people, were not born with their disability
  • we are an ageing population, with growing incidence of complex needs and terminal illness.
  • Lockdown has shown how vital getting out beyond our homes, seeing other people is to our health & wellbeing

change of emphasis?

There is much talk about reviewing the planning guidance and building more homes that are accessible, but most of the housing we will be living in for the next 30 years is already built. 

Therefore, the emphasis has to be on how best to support people in making existing homes suitable for daily living and getting best value.

someone struggles to go upstairs

For example, someone may be struggling to go up stairs. Currently, they would face being kept in hospital until their bed is moved downstairs, only possible if there is room and appropriate bathing and toileting facilities on the same floor, whilst the process of an appropriate adaptation goes through the channels- either a stairlift, through-floor lift or structural change to the home.

The short-term fix adversely impact on their privacy and dignity. It hinders the rest of the household living life. All this time the person concern may have to remain in hospital.

 The long-term fix may not be achievable because of the physical site constraints.  If they live in a flat or a house with steps to the outside, unless re-housed they could become a prisoner in their home.

Yet,in many cases, give that person and their caregiver a stairclimber(https://www.aatgb.com/s-max-sella/)– most likely already available in equipment stores- and they can go home without any furniture removal, still access all levels of their home, AND get outside. It’s a short- and long-term solution, that offers stress-free, timely best value- financially and for the health & wellbeing of everyone involved and saves the NHS significate amounts of money.

a stairclimber makes going up and down stairs easy

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