Proposals to offer routine NHS England services seven days a week have already generated a backlash. The plans may be driven by a desire to reduce the higher death rate for patients admitted to hospital at weekends, but NHS workers have expressed their frustration at the apparent lack of recognition for their existing work.
But the implications of a seven-day NHS reach much further than healthcare employees. Local authorities are subject to fines of more than £100 per day if they are responsible for delaying a patient’s discharge. Yet social workers often have very little time to make any arrangements a vulnerable patient might need upon leaving hospital. Depending on the type of referral, they could be given as little as 24 hours to ensure a safe discharge before the fine kicks in. A seven-day NHS would mean the pressure this puts on social workers would intensify.
Hospital social workers support the most vulnerable patients to leave hospital safely. Their work is varied but predominantly includes working with older people, individuals with dementia, physical or learning disabilities, terminal conditions and people who have suffered life-altering injuries. A social worker will meet with a patient, their family, carers and other professionals in the hospital to ensure they can safely and comfortably return home with adequate support.
This can include commissioning support workers, preparing the physical environment and ensuring the patient is emotionally prepared for life with increased care needs. Hospital social workers also have to assess patients’ ability to contribute to their care planning, something that can require time and a calm, relaxed environment (a luxury not always possible in a hospital).
Growing delays
Hospital social workers’ jobs are already getting harder. The number of delayed transfers out of hospital has risen from 9.6 in every 100,000 patients in 2013-14 to 11.2 in 2014-15. There is also a specific increase in the number of cases where social care is believed to be either entirely or partly responsible for this delay. Although these numbers may seem minimal to those outside the service, the increase represents the intense pressure that social care and social work staff are under following local government budget cuts.
As a former hospital social worker in a pilot extended-hours team, I have seen consultants, doctors, nurses and heath care assistants working all hours in A&E departments and I can vouch for their commitment to their patients. However, increasing the levels of consultant cover on general admissions wards during weekends and evenings by association increases the expectation that patients will be discharged during this time.
The knock-on effect of these plans will be that local authorities will either have to arrange social work cover during evenings and weekends or face even more fines. Both of these alternatives mean further spending in a time of long-term austerity.
And the impact doesn’t end there. Once the social worker has ensured a vulnerable patient is safe to be discharged, they also have to alert any care organisations already working with that patient and explain any changes needed in the level of care.
This will require some level of administrative support for these often small businesses to ensure staff can be contacted and coordinated at short notice. Some patients will also need new services commissioned, which again requires additional support workers to be located who can take on new clients at short notice. This is an unrealistic challenge for small businesses.
Extra bureaucracy
Many local authorities have introduced extra levels of approval before care packages can be commissioned, with managers now having to sign off care plans before they can be implemented. Previously, social workers have had the freedom to commission care without this level of authorisation. This additional bureaucracy was designed to ensure the money spent on care is essential to the patient. Is the expectation that social care management will now work extended hours to ensure this system continues?
Age UK estimates that there are [1.9 million people](http://www.ageuk.org.uk/Documents/EN-(GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true) accessing some type of social care provision in England. These are the people who are likely to be most affected by the seven-day NHS proposals, along with already overworked NHS staff, local authority social workers and support workers.
With a further £1.1bn of cuts across the social care sector expected this year, a big question remains over how local authorities and care agencies will be able to fund an increase in their services to match a 24/7 NHS.