Briefing for the debate on the role of local authorities in supporting hospital discharges

Priorities 

Workforce

The high levels of staff vacancies in the social care workforce continues to be a significant challenge. The British Association of Social Workers (BASW) Cymru reported that care cannot always be provided due to the fundamental problems of low pay and the negative image and poor working conditions that surround care work. Furthermore, the workforce was depleted following Brexit and the Covid-19 pandemic. While international recruitment has been a temporary "saviour" in some areas, it is becoming increasingly legally complex and problematic to sustain. The practical consequence of this shortage is that existing social care staff are being forced to undertake extra responsibilities, including some nursing duties, simply because there is no one else available to perform them.

Addressing workforce shortages and improving integration across health and social care is essential to meeting the demands of a changing population. A long-term plan focused on efficiency underpinned by the implementation of a national recruitment and retention strategy for social care staff, including better pay, clear career pathways and standardised training, is essential. 

Digital

Digital variation is a major hindrance to efficient hospital discharge across Wales. This is because hospital discharge practices vary significantly, with some areas utilising real-time digital systems to efficiently track patient status and care availability, while others are still reliant on paper-based or disconnected systems which directly causes delays in information sharing.

Moreover, data sharing protocols and standardising digital systems is crucial because real-time data access drives efficient, safe and collaborative hospital discharge. Data is vital because discharge is a multi-agency process coordinated across the NHS, GPs, social services and community care. When patient information is fragmented or delayed, the entire process stalls, leading to avoidable discharge delays that keep medically fit patients in hospital beds.

To resolve this issue and achieve a more standardised approach, NHS leaders propose several key digital and data strategies. The most critical step is to establish and standardise the use of electronic care records across all LHB and social care settings to ensure continuity of care and efficient information exchange. Furthermore, enhancing data sharing protocols (akin to the agility seen during the Covid period) enables digital providers to access real-time patient information, meaning the entire care network is instantly updated the moment a patient’s status changes.

Prevention and early intervention

Prevention and early intervention play a foundational role in the entire patient pathway. By strengthening early intervention services, the system can help people live well in their homes, preventing them from reaching the crisis point that necessitates an emergency hospital admission. There needs to be an increased focus on community-based support rather than acute hospital care. Community-based support is essential to avoid preventable admissions and resolve the systemic pressure on hospitals. 

To fix this, continuous engagement between Local Authorities (LAs) and Local Health Boards (LHBs) is essential to prevent avoidable admissions, ensure true integration and comply with the statutory duties under the Social Services and Well-being Act 2014, with a vital focus on the prevention and early intervention agenda. Ultimately, this strategic shift must be backed by implementing innovative and flexible care models such as expanding hospital-at-home services, developing rapid response home care teams and establishing integrated prevention of admission teams. 

Sustainability of the social care sector

Social care sector is facing significant challenges, including vulnerabilities in funding, high demand and high levels of staff vacancies. This crisis means that social care services are struggling to support people to remain independent. 

The challenges within the social care sector can have a significant impact on the NHS and on people’s health and wellbeing if they have to go into hospital and then are unable to be discharged in a timely way. Prolonged, unnecessary hospital stays expose patients to risks like hospital-acquired infections, lead to muscle wastage and loss of mobility and impact on people’s mental health. Systemically, these delays slow the flow of patients throughout the entire hospital, impacting the Welsh Ambulance Service response times, reducing elective capacity and disrupting planned care. The core issue of discharge delay is attributed to a complex interplay of factors, including workforce issues (low pay, high turnover and staff shortages), systemic inefficiencies (delayed assessments and bureaucratic processes) and difficulties in arranging appropriate post-discharge care (lack of care home availability or home care capacity).

There needs to be an independent rapid review to develop a long-term agreement on the sustainability of the social care system. This review is vital to address system-wide challenges and stabilise the social care system through sustainable funding and resourcing. The review must also focus on measures to improve the timely discharge as well as the flow and efficiency of the social care system, acknowledging that social care is intrinsically linked to the effective performance of the NHS.

Long-term funding

Social care services are facing significant challenges, including vulnerabilities in funding and market stability, which impacts the sector's sustainability. LA representatives reported that due to budgetary pressures, they have been forced to reduce spend on and priority given to early intervention and preventative services. 

Additionally, there is variability in how NHS Continuing Healthcare (CHC) funding is applied, which can lead to disputes over who funds post-discharge care. Also, the limited availability of care homes and placements is partly due to many care homes facing funding challenges, leading to closures or reduced capacity. There is a risk that care homes will focus their offerings on self-funders and less complex residents because complex care is not always funded appropriately.

Long-term social care funding is an essential financial necessity for the NHS. Adequate, long-term funding is required to transition the focus of care away from hospital setting and toward proactive community support.

Conclusion

Social care is an essential service that helps people live the life they want to live. The challenges in the current social care sector means that people are missing out on vital care and support, leaving them less independent, more vulnerable and more likely to rely on healthcare services. 

The NHS is reliant on a sustainable social care system as capacity and workforce issues in social care have implications on patient flow through hospital, impacting the NHS’s ability to discharge large numbers of patients from hospital. There is evidence that closer working between local authorities and the NHS on the joined-up planning and commissioning of services helps people to recover and keep well. This involves focusing on prevention and early intervention and making better use of primary care and community services. However current funding models can increase competition, we need incentives and ways of working that drive cooperative working, for instance, measuring the performance of the whole systems.

Further information

If you would like further information on any of the issues raised in the briefing, please contact Haleema Khan on haleema.khan@welshconfed.org 

The Welsh NHS Confederation is the only membership body representing all the organisations making up the NHS in Wales: the seven local health boards, three NHS trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales and Health Education and Improvement Wales). We also host NHS Wales Employers and are part of the NHS Confederation.