14 February 2003
Social services directors this week urged the government to delay the introduction of council fines for hospital 'bed-blocking', as a critical report by the National Audit Office exposed the extent of the problem.
The Association of Directors of Social Services said that far from creating an environment in which councils can resolve the crisis – which the NAO claimed leaves 4,100 'fit' older people unnecessarily trapped in wards every day with no access to post-hospital care – it will exacerbate problems.
Health Secretary Alan Milburn will shortly begin fining councils £100 per patient per day if they fail to provide adequate post-hospital care either in places such as residential homes or at home. Milburn believes this will help the government achieve its target of eradicating 'widespread delayed discharges' by 2004.
But Dr Glenys Jones, chair of the ADSS's older people's committee, said the system of fines was a distraction from the real issue – a glaring lack of capacity in post-hospital care . 'The bottom line is that not enough cash is getting through to councils that want to raise and build capacity in intermediate care, such as more homes for the elderly.
'How on earth will fining authorities resolve this situation? It will further rob us of much-needed cash. We've urged ministers to delay fining councils to allow us to build capacity first.'
The NAO report, published on February 11, found that although the NHS has made progress in reducing delayed discharges, notably through the distribution of a £300m grant to councils, bed-blocking is still rife.
Around 9% of older patients occupying beds in NHS acute hospitals are ready to leave and, at any one time, an estimated 1,300 are being delayed unnecessarily for more than a month.
The NAO said delays could 'significantly affect a patient's physical and mental wellbeing,' and claimed the total cost of bed-blocking was anywhere between £250m–£750m a year.
Bed-blocking could even be worse than official figures suggest, because almost three-quarters of hospitals do not keep accurate records.
The NAO suggests that the shortage of places in care homes is 'the most significant constraint' on resolving the crisis. It urged wider use of the independent sector and better information-sharing between hospitals and social services departments.
Edward Leigh, chair of the Commons' Public Accounts Committee, said: 'It is intolerable that every day 4,000 older people are trapped in hospital simply because the public services cannot get their act together.'
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