Who cares? Why lack of social care is the biggest contributor to delays in hospital discharge

Published 06/10/2022   |   Reading Time minutes

Lack of social care capacity is the biggest contributor to delayed discharges and restricted patient flow through hospitals – this was the conclusion of the Senedd’s Health and Social Care Committee’s recent inquiry.

The scarcity of available homecare support is having a severe impact on services, patients, and their families/carers. Angela Davies (an unpaid carer) told the Committee her father “spent seven months in hospital purely waiting for a care package”.

Current situation

Unprecedented social care staffing shortages mean care assessments in hospital are often delayed, and services for homecare packages aren’t available to enable safe discharge.

Welsh NHS leaders recently said there is a "national emergency" in health and social care due to the lack of care workers. The Welsh NHS has said up to 1,500 people in hospital are ready for discharge, but cannot leave because of a lack of social care services.

The Association of Directors of Social Services (ADSS) Cymru told the Committee, “we’ve had over 1,000 hours of domiciliary care [homecare support] that we’ve been unable to commission that are waiting for support within the community”.

One of the areas most affected by delayed transfers is the ambulance service. Ambulances are often seen queuing outside A&E departments across Wales. This impacts on the number of ambulances available to respond to emergency calls, leading to long waits for people in need, in some cases with life-threatening consequences. The Welsh Ambulance Service Trust described the position as “extreme and sustained”.

Stakeholders like Care Inspectorate Wales also raised concerns that lack of available homecare support has led to people being placed in residential care. It is intended to be an interim measure but often these people end up being unable to return home.

Whilst this is intended as a short-term measure, many care homes lack capacity to continue to promote people’s independence so they can live at home when a domiciliary support package is available. Our concern is this is reversing the policy objective of many years of supporting people to live at home. (Care Inspectorate Wales)

Another clear area of concern was the pressure being placed on family and unpaid carers to fill the gaps in care provision. Our recent article “No respite for unpaid carers…” provides more information.

The Committee concluded unless radical steps are taken to reform the way social care is provided, rewarded and paid for, we’re unlikely to see any real change.

It notes Senedd Committees have long called for parity in pay and terms and conditions for social care staff with their NHS counterparts. It says until this is achieved, the sector will continue to struggle to recruit and retain staff.

The Welsh Government’s response emphasises its commitment to improving terms and conditions for social care workers, and says delivering the Real Living Wage is a starting point for this. The Welsh Government said it will continue to work in partnership through the Social Care Fair Work Forum to ensure it brings about long term, sustainable change.

Issues to watch

Unpaid carers rights

The Welsh Government accepted the Committee’s recommendation to undertake a rapid review of whether carers’ rights under the Social Services and Wellbeing (Wales) Act 2014 are being breached. Carers Wales raised concerns about this, with carers taking more caring responsibilities than they may be willing or able to handle, due to lack of available care services.

The Welsh Government said the Chief Social Care Officer has identified unpaid carers as a priority area, and will commission a review in this financial year of the quality and effectiveness of carers’ needs assessments. This will consider whether the rights of unpaid carers under the Act are being upheld.

The Welsh Government has also just published a Carers Charter to highlight unpaid carers’ existing legal rights.

Sickness pay for social care workers

The Committee asked for an update on work to address sickness pay for social care workers.

The Welsh Government subsequently announced that the Covid-19 statutory sick pay enhancement scheme would not be further extended. It came to an end on 31 August. The scheme ensured social care workers who were required to self-isolate or stay home due to Covid received full pay. This was introduced in recognition that most social care workers received only Statutory Sick Pay (SSP) when they needed to stay off work due to Covid-19, or no income at all if they did not qualify for SSP.

The Welsh Government said that with decreasing Covid-19 cases in the community, Covid-19 should be considered alongside other respiratory viruses. It also pointed to the Covid-19 autumn booster which is being prioritised for frontline social care staff and older care home residents.

Winter pressures ahead

Unions such as UNISON Cymru/Wales have warned the decision to end the scheme will cause impossible dilemmas for many care workers this winter, and “could provoke a deepening crisis in care”.

If there is another, more transmissible or more severe new strain of the virus, tens of thousands of already low paid care workers, will face a double whammy of the cost of living crisis and being plunged into greater poverty simply because they are ill, or to protect our vulnerable. It’s not sustainable and it’s not acceptable.

Our recent article on the cost of living pressures in social care highlights the damaging impact of the rising fuel costs on the domiciliary care workforce.

UNISON Cymru/Wales and other trade unions believe issues like proper sick pay for care workers should be top of the agenda, and are calling for care workers to receive decent sick pay before winter pressures hit.

According to the Welsh NHS Confederation, NHS leaders expect the situation with care staffing shortages to deteriorate over winter.

These issues are likely to come up in the Senedd debate on 12 October 2022 on the Health and Social Care Committee’s report: Hospital discharge and its impact on patient flow through hospitals.


Article by Amy Clifton, Senedd Research, Welsh Parliament