Hospital discharges limiting home care in England, councils say

Vulnerable people face being denied basic preventive social care at home due to a wave of rapid discharges from hospitals that is sucking up resources, council bosses have warned.

Despite cross-party support for more early care at home, town hall officials are having to allocate resources to people with more complex needs, many discharged from hospital early as part of attempts to clear NHS backlogs.

It means thousands of others were “at risk of missing out [on care] or their needs escalating”, warned the Association of Directors of Adult Social Services in England (Adass) after its annual survey of England’s 153 council social care directors.

It revealed that only one in 10 directors were fully confident their budgets would meet their statutory duties – down from more than a third before the Covid pandemic.

One social care leader, Jane Townson, the chief executive of the Homecare Association, likened the pressure of the current situation to “juggling flaming torches”.

Spending aimed at preventing people’s conditions from worsening was forced down by £121m over the past year. As the complexity of cases increases, councils overspent by £586m – the highest level for at least a decade, triggering raids on dwindling council reserves .

The findings were “unsustainable and worrying” said Melanie Williams, the president of Adass and director of adult social care at Nottinghamshire county council.

“Instead of focusing on investment in hospitals and freeing up beds, the new government must shift to investing in more social care, supporting unpaid carers, and providing healthcare in our local community to prevent people reaching crisis point and ending up in hospital in the first place,” she said.

Helen Wildbore, the director of Care Rights UK, which represents care recipients and their families, said behind the statistics were “people whose lives are being destroyed by budgets stretched to indignity 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 and disabled people in the most vulnerable of situations must top the list.”

There was some good news, however, with an 11% fall in the number of people awaiting care or an assessment in the six months to 31 March 2024, to 418,029.

Labour has pledged to create a national care service; to build closer partnerships between hospitals and the care sector to manage hospital discharge; and to explore boosting care workers’ role in basic health treatment and monitoring.

But it has not made any funding announcements and stressed on Monday it was in the early stages of a new government. Last week, the health secretary, Wes Streeting, said he would divert money from hospitals to GPs to provide “more care available closer to people’s homes”.

The increasing complexity of need among people discharged from hospital, and the growing demand for “double-handed care” are significant concerns. There was a 7.5% increase over the last year in the number of people requiring visits from two or more care workers. The average number of home care hours provided for each person by councils rose from 697 in 2022 to 750 in 2024, leading to a rise in spending on home care by just over a quarter during that period.

Martin Tett, the leader of Buckinghamshire county council and the County Councils Network spokesperson 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 requiring more complex care and local authorities overspending on their budgets as a consequence.

“Ministers must set out sustainable and long-term funding for councils, distributed according to local need.”

A spokesperson for the Department of Health and Social Care said: “We are determined to tackle head-on the significant challenges social care faces. We will undertake a deep-rooted programme of reform to create a national care service and make sure everyone gets the care they need.”