Q&A: Bed-blocking

Three and a half thousand elderly people a day remain in hospital when they are well enough to be discharged because the care they need is not ready, MPs have claimed.

BBC News Online looks at the issues behind the "bed-blocking" problem.

What is "bed-blocking"?

The term refers to elderly patients who remain in hospital after their treatment is complete because there is nowhere suitable for them to go.

Because they are taking up the bed, no other patient can be admitted for routine surgery or emergency care, thereby 'blocking' the flow of patients through the hospital.

It has been estimated that up to two million bed days could be lost to the NHS each year because of the problem.

Why does it happen?

When these patients leave hospital, they become the responsibility of social services departments instead of the NHS.

This means there are bureaucratic hurdles to overcome as responsibility for the patient moves from one agency, with one budget, to another.

Delays can stem from financial disputes, long assessment procedures or problems accessing the right kind of care for the patient, whether that be a nursing home place or home help services.

Patients can be in hospital for up to a month longer than they need to, because of these delays.

What should happen when a patient is due to leave hospital?

Patients need to have a discharge plan agreed by both health and social services care staff saying where they should live and what kind of care they will need.

This may be a nursing or residential home place, a place in sheltered housing, or returning to their own home - perhaps with rails or other special equipment to assist them or home helpers caring for them.

All of these things can take time to arrange, and the report from the Public Accounts Committee says arrangements are simply made too late during a patient's hospital stay for them to be ready in time.

Edward Leigh, the committee's chairman, says discharge plans should be being made from the time the patient is admitted to hospital, if not before, so that there is time for arrangements to be put in place.

What has the government done to tackle the problem of bed-blocking?

The committee accepts that it has already made significant cuts in the number of delayed discharges since being elected in 1997.

It has also passed the Delayed Discharges Act, which introduces fines for social services departments who fail to find accommodation for elderly patients leaving hospital.

If social services fail to find a place within a set time period, they have to pay a fine to the health service so it can recoup its costs.

The government says funding of £50m this year, and £100m next year will be sufficient to foot this bill.

Is this going to solve the problem?

The Bill will not come into force until next year, so its effect will only be seen then.

However, the Public Accounts Committee has warned that other measures are needed to ensure bed-blocking can be reduced.

It says more physiotherapists and occupational therapists, who play key roles in planning discharges, are needed.

Charities for the elderly say more care home beds are also needed, so that patients have places to go to.

And there are also concerns that the fines may act as perverse incentives for patients to be discharged from hospital before they are well enough, or without the appropriate follow-up care being arranged.

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