The loss of community hospital beds was intended to be offset by increasing the capacity of community care so that patients could be cared for in their own homes. This may or may not have been realistic since many of the patients in the hospital system cannot be managed in the community even with excellent community services.
However, with or without community hospital beds it is an excellent idea to expand community services so that all those patients who can be cared for out of hospital can remain at home. Unfortunately there is not sufficient capacity in the home care services to do this job.
When GPs ring the single point of access number asking for rapid response or night sitting, the carers are not available. This is partly due to lack of resources and partly due to difficulty with recruitment. I suspect that part of the difficulty with recruitment may be due to the terms and conditions. If the carers only get paid if they are required then this may not be particularly attractive.
We understand that a hospital only functions well with a maximum of 85% bed occupancy, and similarly with the home care service we need to accept that there will be some unused capacity otherwise the service is never able to accept unexpected cases. Thus we need to allocate enough resource so that we can offer both an attractive rate of pay and attractive terms and conditions.
This is in fact an essential part of the answer to the problem the entire NHS is experiencing. If the level of water in a reservoir is steadily rising and then overflows, you can either try and build the banks higher in which case it will just overflow a bit later, or you can look at the streams going in and going out of it.
Similarly when you see an overflowing A&E or hospital you can buy more A&E or acute beds (very expensive) or you can increase community capacity to prevent people going in and facilitate people coming out (relatively much cheaper but you still have to pay a proper rate for it).
Pic: Dr Slot presenting to the committee last Thursday.