Exclusive: Treasury ‘the barrier’ as full hospitals desperate to discharge patients to social care

Hospitals, particularly in London and the surrounding areas, are seeing very high and rapidly growing numbers of covid-19 admissions, and are running out of options to free up beds. Multiple senior NHS leaders said they need to discharge more patients to care homes, but that this had become increasingly difficult.

Beds in many care homes are lying empty, but many care providers are refusing to accept residents where there is a risk of introducing covid-19 and fear of repeating the disaster of the spring in the sector.

Part of the problem is some care providers which would otherwise become covid-designated homes say they are not insured for the risk of doing so.

HSJ understands national officials in the NHS and government are now considering options to try to alleviate the problem, amid urgent requests from local NHS leaders, including paying for the additional insurance cost.

However, sources said the Treasury had not yet been willing to foot the bill.

‘Pick up the tab’

A senior local authority source told HSJ many care homes were unable or unwilling to take on the increased premiums. The source said: “The ask is an additional financial burden on providers and someone needs to pick up the tab. The obvious department to do so is the Treasury and that is where the barrier is. There is a sense that the government are hoping the insurance issue will just disappear.”

And NHS Providers chief executive Chris Hopson said: “The government needs to provide appropriate financial incentives to make these [social care] beds available on an emergency basis and to cover costs such as higher insurance premiums.

“The NHS needs to recognise the higher level of need any rapidly discharged patients are likely to have and treat these beds as extensions of community capacity, in particular providing prompt and regular access to high quality therapies.”

Other options under consideration include the NHS block booking care homes, and somehow contracting providers to accept patients even where they perceive there is a small risk of covid infection. Some are said to be rejecting those who have tested negative but have previously been in contact with people with covid, for example.

The solutions are likely to involve the need to send some NHS staff in to homes to provide additional health support, to help care providers manage infection risk, and because the patients may require additional step-down care. 

One system leader said “all options are being looked at”. A statement issued before Christmas said NHS community hospitals should be used, with this capacity substituted in care homes, but it has not solved the problem.

‘Getting very scary’

Another well-placed source told HSJ: “There is the sense that, because the government’s fingers got so burnt [on the care home issue] in March and April, it its running scared to have a discussion about what role they should play now, or even to be seen to have a discussion. But now it does really need to step up and play its role here given the position hospitals are now in.”

One senior local leader said of the situation with hospital capacity: “A single patient could topple the system over. It is getting very scary. There are no community beds at all. We have empty beds in care homes but they just won’t accept people as everyone is scared. Local cooperation is really good but we are running out of ideas [as to how to discharge people].”

One senior provider source said: “We are now in danger of putting patient care at risk by not maximising use of the care sector.”

Mr Hopson added: “NHS hospital, community beds and community run at home services are now rapidly reaching capacity in some places. Clinical risk is therefore rising. Trust CEOs are saying that there is significant available capacity in the care and nursing home sector in many systems but, for a variety of understandable reasons, they are finding it difficult to access that capacity.

“Trust leaders are clear that, looking at the overall balance of risk [to patients and care home residents] and the best outcomes for the largest number of people, accessing this capacity has now become critical in many systems. We need to solve this at incredible pace, in the next few days or so.”

Government response

HSJ previously reported a new discharge system set up by the Department of Health and Social Care in the autumn had made discharges much more complex. However, in December, DHSC accepted its plan to only allow hospital patients to be discharged into specially designated covid-positive care homes was failing as there were not enough of these specialist beds available.

On 16 December, the department said patients could be discharged to any care home bed available in special circumstances. Despite this move, it is understood many homes continue to refuse to accept new residents, as they are fearful of a repeat of the mass fatalities experienced in the sector in the first wave.

A DHSC spokesman said: “No care home should be forced to admit an existing or new resident if they do not feel they can provide the appropriate care. We are putting in place designated care home or NHS community settings that can provide covid-positive residents with the care and support they need, while protecting other vulnerable residents from the risk of infection.”