Unpaid Carers: Patient Hospital Discharge

Question

Asked by

To ask His Majesty’s Government what assessment they have made of the extent to which unpaid carers are consulted before a patient is discharged from hospital, and what plans they have to monitor this.

My Lords, the Health and Care Act 2022 requires NHS trusts to involve patients and unpaid carers in discharge planning, reinforced by 2024 discharge guidance. However, this is not always done consistently and carer involvement is not monitored nationally. We will support better implementation by commissioning work from the LGA’s better care fund support programme this year. Care transfer hub guidance also promotes best practice by encouraging early identification and involvement of carers in planning.

I thank my noble friend for her Answer. It was important, though not easy, to win for carers the right to be consulted at the point of discharge. I am sorry that better statistics are not being kept, but I am glad to hear the plans for improvement. The survey from Carers UK shows that the number of carers being consulted is decreasing rapidly. Although I fully understand the pressure on the NHS at the point of discharge and the difficulties of securing proper social care support, does my noble friend agree that it is very short-sighted not to consult carers at this point? If they break down from lack of support, the patient is readmitted and there is further pressure on the NHS.

I completely agree with my noble friend that the involvement of and support to unpaid carers is crucial when a patient is discharged because, as she says, it is vital not just for patient recovery but for the whole healthcare system. I welcome the recent Carers UK report that was published last year, which focused on how government legislation and guidance is or is not being implemented and monitored in practice. That has been and will be very useful work for us to continue with.

My Lords, further to the question from the noble Baroness, Lady Pitkeathley, there are 120,000 young carers aged between seven and 18, many of whom are the principal carer for a parent or sibling, accompanying them when they go into hospital. Although many hospitals are good about identifying the young carers, not all of them are. What more can be done to make sure that these young carers are identified right at the beginning of the process and fully consulted about arrangements for discharge?

The noble Lord is right to emphasise the role that many children and young people have as young carers. The Children’s Social Care National Framework is statutory guidance for local authorities, which have duties to identify young carers who may need support and to assess their needs. I am well aware that young carers may not be aware of this, but there is a right to request assessments. Improving joint working between adult and children’s social care services, as well as health services, is key. Lastly, I hope that the electronic patient record would identify where there was a carer, including a young carer.

My Lords, I declare my interest as a vice-president of the LGA. The model of unplanned discharge places an immediate burden on unpaid carers. What assessment have the Government made of the financial impact on unpaid carers during this period? Specifically, will they consider a discharge support grant to provide immediate short-term funding for carers for the first four weeks following an unplanned or non-thought-through discharge?

I know the noble Lord will be aware of the better care fund, to which there is a commitment of some £9 billion. It can be used in various ways, including in the way that he described. I look forward to the work of the LGA’s better care fund support programme that we will commission this year so that we can work with NHS and social care partners, because we need to strengthen the approach of not just involving but supporting unpaid carers. Discharge should not take place if carers are not able to fulfil the duties that it is assumed they can fulfil.

My Lords, it is good to hear that there is real awareness of the issues caused by this. It is one of the most acute problems in the whole provision of social care, and it falls hard on unpaid carers when they do not even know how or who to ask for help. It has been diagnosed many times as a big issue. There used to be co-ordinator discharge people in hospitals who would help with this process. Are there still such posts? The news about the LGA work is welcome in relation to co-ordination when it counts and support for unpaid carers, who are the experts here. They are not passive arbitrators; they need to have their own knowledge and expertise recognised in this process. Is there provision at the hospital level for this?

My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.

My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?

The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.

My Lords, although the better care fund is a help, its success depends on how hospitals and the LGA work together. Would the Minister agree that the fund is still used to fund short-term gaps, particularly winter pressures, and that the yearly funding cycle does not help for longer-term planning? Could that be improved?

I can see the pressure and difficulties that can bring. There is a range of reasons why discharges do not take place in a timely fashion—not just processes but the interface between health and social care, and capacity. As we look at how we involve carers and improve discharge rates, matters of funding will be key.

My Lords, we live in a world where we have constant criticism, both of government—rightly, quite often—and of many individuals for their behaviour. But here we have a situation where the health service and, indeed, society are being saved many billions of pounds as a result of the work of people who volunteer to care for their relatives and others—those in the voluntary sector, in our hospice movement and all over the health service. Without these people, we would be in real trouble. Is it not marvellous, and can we perhaps commend them and approve of what they are doing both to save us resources and to show that people are basically good?

I am very grateful to the noble Lord. I and the Government are certainly cognisant of the role that unpaid carers play. That is why, last year, we increased the carer’s allowance weekly earnings limit. This was the largest cash increase ever and means that 60,000 additional carers will qualify. That is part of our recognition, but I share the views the noble Lord has given and the comments about my noble friend Lady Pitkeathley and Carers UK—I am grateful to all.