WARRINGTON Hospital is already facing a major capacity crisis – with around one in four beds occupied by patients who are medically fit to leave – and now the NHS trust’s chairman has warned proposed £34m adult social care cuts could make the situation dramatically worse.
Andy Carter, the former Warrington South MP who is now Chair of North Cheshire and Mersey NHS Foundation Trust, has written directly to Warrington Borough Council Chief Executive Sarah Smith and leader Cllr Hans Mundry, warning that reducing adult social care capacity could simply shift costs and pressure from the council into the NHS.
His letter comes as the council prepares to push ahead with the next phase of its financial recovery programme, with a staggering £118m budget gap in the current year and £179m across the Medium Term Financial Plan period.
Of the £51.243m of proposed Phase 2 savings, £34m – around two-thirds of the total – falls on adult social care, with an estimated staffing impact of between 70 and 100 full-time equivalent posts.
Mr Carter makes clear that he understands the financial pressures facing the council.
But he warns that the consequences for Warrington Hospital cannot be ignored.
In a strongly worded letter to council leaders, he states that adult social care is currently “the single greatest constraint” on the Trust’s ability to care for Warrington residents.
And the figures make for uncomfortable reading.
Around a quarter of the Trust’s bed base is currently occupied by patients who have no criteria to reside, compared with a national figure of around 15 per cent.
That means Warrington is approximately ten percentage points above the national average and, according to Mr Carter, is among the worst-performing areas in the country.
Put simply, roughly one bed in every four is occupied by somebody who is medically fit to leave hospital but cannot do so because a package of care or a suitable placement is unavailable.
And the consequences are being felt right through Warrington’s health service.
Mr Carter warns that when patients cannot be discharged, beds cannot be freed for people arriving at the emergency department who actually need admission.
The result is a vicious cycle of delayed discharges, overcrowded emergency departments, ambulance handover delays and patients waiting for hours for treatment.
He says the delays contribute directly to some of the **worst 12-hour wait performance in the country – as well as patients receiving care in hospital corridors.
Ambulance crews are also affected because delayed handovers prevent them from leaving the hospital promptly to respond to their next emergency call.
Perhaps the most striking element of Mr Carter’s warning is his comparison between the hospital’s emergency department performance and the wider problems caused by patient flow.
He says the Trust has made substantial progress on the four-hour measure, moving from 110th to 23rd nationally over the past 12 months.
But on the measure which depends upon patients being able to move out of hospital beds, Warrington remains near the bottom of the national table.
Mr Carter says that contrast is important because it demonstrates that the problem cannot simply be blamed on the hospital itself.
“That is not a difference in effort, process or leadership,” he writes.
Instead, he describes the difference as being between “a problem inside our walls and a problem within the system in which we operate.”
And the human cost, he warns, falls on two groups.
Older people can spend unnecessary days in hospital, becoming weaker and losing confidence and independence – potentially reducing their ability to return home.
At the other end of the system are acutely unwell patients waiting in emergency departments for beds which could have been released through timely discharge.
Mr Carter’s message is blunt: these are not two separate problems. They are the same problem seen from opposite ends of the hospital.
The Trust chairman is not opposing the council’s financial recovery programme outright. Indeed, he acknowledges the scale of the council’s financial problems and says the necessity of Phase 2 is not in question.
His concern is the heavy reliance on adult social care cuts.
He points to the possibility of achieving savings through different approaches, including better use of public sector buildings, shared back-office functions, digital efficiencies, reducing duplication, changes to care models and workforce deployment, and expanding step-up, step-down, intermediate care and reablement services.
He also highlights the potential for more community-based support to prevent people needing hospital or long-term care in the first place.
The key issue, he says, is whether those alternatives have been properly explored before reductions in frontline adult social care capacity are implemented.
Mr Carter is also challenging the council over the extent to which health partners were involved in developing the proposals.
He points out that the financial report does not record engagement with the Trust, NHS Cheshire and Merseyside ICB or the Health and Wellbeing Board – despite joint work already taking place on delayed discharge.
He says the conclusions from recent system summits held at the hospital, specifically to address delayed discharge, do not appear to be reflected in the report going before Cabinet.
And he raises a fundamental question over whether the proposed savings will genuinely save public money.
“A delayed discharge does not remove cost from the public purse,” he warns.
Instead, the cost can be transferred into the NHS – while residents suffer longer hospital stays, lost mobility and independence, or longer waits for treatment.
He also warns of the potential impact on the already stretched care provider market, including the risk of contract hand-backs in domiciliary and residential care.
Mr Carter says the council’s ambition to keep people well and independent in their own homes is one he shares.
But he warns that prevention takes time to deliver results, while cuts to existing capacity can have an immediate impact.
“Reductions in capacity are felt immediately, and they are felt first in our beds and then, within days, at our front door.”
His argument is ultimately that Warrington cannot afford to look at the NHS and social care as two separate financial systems. Residents experience them as one system.
And if cuts simply move the problem from one organisation to another, the financial saving may prove illusory – while the pressure on Warrington Hospital becomes even greater.
Mr Carter has called for the council and NHS to work together on shared modelling of demand and costs, transfer-of-care arrangements, trusted assessor arrangements, joint commissioning and the use of NHS estate and workforce.
His closing message is clear: “Our two organisations serve the same residents, and neither of us can resolve this alone.”
With Warrington already struggling with hospital capacity, lengthy waits and patients being cared for in corridors, the warning from the former MP now leading the local NHS trust places a major question mark over the council’s proposed social care savings – and whether they could ultimately leave Warrington paying a much higher price elsewhere in the public sector.
