The must-read stories and debate in health policy and leadership.

Many in the NHS will have come across patients being discharged to less-than-optimal placements but it is rare for this to be discussed in public.

But East Kent Hospitals University Foundation Trust’s board papers from last week made it clear that a shortage of domiciliary care meant some patients who could go home – with help – were instead being sent to care homes.

That could mean patients “deconditioning” as they stay in care homes or community hospital beds rather than recovering at home – where they may be more active and move towards independence in familiar surroundings.

That’s bad for patients but keeping them in a bed may also be bad for the NHS and local government. A care home bed is likely to cost more than home care visits in the first place and, if it leads to deconditioning, may mean people stay in them for longer – and potentially never return home.

But creating more home care capacity is likely to depend on better pay and conditions for those who deliver this, often spending hours driving between clients to deliver short “packages” of care, and there seems little hope of funding for that currently.

Requires improvement?

Is the Care Quality Commission guilty of “ratings inflation”, ask HSJ’s Alastair McLellan and Dave West in their editorial.

By many of the CQC’s standards, the NHS has apparently become better and safer since its four category classifications were introduced 10 years ago but does this reflect reality, they ask. How can it be?

“There is one obvious answer to this conundrum. The CQC has inspected few trusts during the pandemic and has, therefore, not had the opportunity to gauge the impact covid has had on the NHS.

“This would suggest a very significant downgrade in ratings is in the pipeline to reflect the new reality.

“However, neither the government, the CQC or NHS would want this, and it is unlikely to happen.

“The problem is that leaves a set of ratings which bear little relation to the state of NHS services and how they have changed over the last few years.”

So does this rating “inflation” matter? The authors argue that it does for three reasons, one being that it allows government to paint a rosier picture of the service than is justified and enables the fiscal hawks within the administration to argue more strongly that the service is doing just fine.

Read the full piece here.

Also on today

In news, we report on figures showing the number of NHS hospital staff off work for covid-related reasons rose by a fifth in 10 days, and there’s a chance to catch up on the latest rewards in our Ukraine appeal.