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The state of health care and adult social care in England, released 9th Oct 2017

"The biggest challenge that hospital trusts face is maintaining a consistent flow of patients through the acute medical and surgical pathways. Without adequate flow, they are unable to respond effectively to the rising number of urgent patients and to admit elective patients in a timely manner. Poor flow leads to too many ambulances delayed at the hospital front door, too many patients suffering long waits in emergency departments for admission, too many patients being admitted to an inappropriate ward, too many patients suffering multiple moves between wards, delaying and disrupting their care, and too many patients having operations cancelled at short notice. Follow-on care for people leaving hospital is often not there. With a reduction of long-term care beds in some areas and a lack of these beds in other areas, care homes in high demand have waiting lists or may have several people who could use an available place. As a result, people remain in hospital beds unnecessarily while others need hospital services and beds. Over the past three years, delays in transfers of care have all increased substantially. The majority of days delayed are still attributed to the NHS (55% in March 2017).44 However, the sharpest increases have been in certain adult social care attributed delays. Delays for people waiting for home care packages have seen the largest increase (figure 1.18) – from April 2014, days delayed due to awaiting a home care package more than tripled to more than 42,000 in December 2016, although since then there have been signs of an improvement, with monthly days delayed falling to 37,000 in June 2017. Overall, keeping patients in hospital longer than required can have a number of detrimental effects. Long stays can affect patient morale, mobility, and increase the risk of hospital-acquired infections. There can be a damaging effect on people delayed in hospital: research suggests a wait of seven days is associated with a 10% decline in muscle strength.45 To investigate these issues further, CQC has been asked by the Secretaries of State for Health and for Communities and Local Government to carry out a programme, in the second half of 2017/18, of local system reviews of health and social care in 12 local authority areas. A further eight sites will be identified in the coming months. Once we have completed all 20 reviews, we will publish a national report of our key findings and recommendations in 2018. We are looking specifically at how people move between health and social care, including delayed transfers of care, with a particular focus on people aged 65 and over. The review does not include mental health services or specialist commissioning but, through case tracking, will look at the experiences of people living with dementia as they move through the system." READ THE REPORT IN FULL HERE

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10 October 2017

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