Health secretary Wes Streeting has been urged to speed up reforms to the adult care system in the wake of patient deaths after two coroners warned him of the impact insufficient care beds and service provision are having on the NHS.
Last month, coroners sent two prevention of future deaths (PFD) reports to the Department of Health and Social Care (DHSC) after the inability to discharge patients at two hospitals was linked to the deaths of others awaiting treatment.
In the first case, a man died “following a grossly excessive ambulance delay attributable to a systemic failure related to the whole system of health and social care”, according to the PFD report from Guy Davies, assistant coroner for Cornwall and the Isles of Scilly.
The total ambulance delay of nearly 19 hours was judged by the inquest to be “possibly causative of death”.
The inquest found that when the ambulance reached the Royal Cornwall hospital in Truro, there were 11 others queueing to hand over patients to A&E, which was built to house 44 patients but was holding 56.
The lack of available beds was the result of patients who were ready for discharge but forced to remain in the hospital because of “inadequate social care provision, community hospital provision and primary healthcare support”.
Labour’s election manifesto pledged to create a national care service, but the only specific commitment towards this was a fair pay agreement in adult care, falling short of the programme detailed in a Labour-commissioned report by the Fabian Society thinktank last year.
Since the election, the Labour government has abandoned the long-delayed Dilnot reforms to funding care costs, but announced little else.
“Too many people are stuck in hospital, unable to leave due to a lack of social care and support in the community,” said Ben Cooper, research manager at the Fabian Society and co-author of last year’s report. “This is felt throughout the NHS, with worsening wait times for ambulances, and in A&E, and devastating consequences for patients. Fourteen years of Conservative failure to act on social care has contributed to a significant NHS challenge for this government.
“Ultimately, the government’s promise of an NHS fit for the future requires a national care service. Social care in England needs comprehensive reform, so that everyone has access to support when they need it, including when they leave hospital.
“If the government doesn’t start to act now, wait times for ambulances, A&E and other care will not fall and the NHS will continue to struggle. The government should prioritise a long-term plan on social care, alongside its 10-year plan on the NHS.”
In his report, Davies highlighted the fragmented structure of the adult care system. “There is no single organisation with responsibility to ensure that the provision of social care is sufficient to avoid delayed discharges leading to ambulance delays,” he wrote. “The obligation upon local authorities is limited to a requirement to promote the market.”
A Cornwall council spokesperson said: “In spite of the national challenges, which are well recognised, … and the continued delays around the national policy reforms, Cornwall council has made significant investment in adult social care and is delivering new capacity across a range of services with our providers. We are also working very hard to attract more people into Cornwall’s care sector.”
The second PFD report concerned a patient in Manchester who was kept in hospital for a month after he was ready for discharge, because of difficulties finding a suitable care home place over the Christmas period last year.
“The inquest heard evidence that it meant that an acute bed was not available creating delays in allocating beds to patients requiring admission,” the report said.
The DHSC said: “Our deepest sympathies are with all those impacted by these tragic cases.
It is important we learn lessons from PFD reports, and we will consider these reports carefully before responding.
“We are committed to reforming the sector and, as set out in the manifesto, will take steps to create a national care service, to improve consistency of care across the country, and will establish a fair pay agreement for care professionals.”