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Most hospitals in England do not charge local authorities for “bed blocking,” the term that describes extra stay in hospital because social services have failed to provide the care services that patients need after discharge, new research has found. However, it also found that the NHS, rather than local authorities, is responsible for two thirds of the number of bed days resulting from delayed discharge.
“There is no evidence to support government policy of charging social service departments for delay,” say the authors of the study, which provides data from across England on delays in discharge of patients from acute hospitals since the Community Care Act was introduced in 2003 (Journal of Public Health doi: 10.1093/pubmed/fdm026). This act gave NHS hospitals the power to charge social service departments a daily tariff (£120 (€180; $240) in the South East and £100 in the rest of England) where social services failed to provide the required care services, such as a place in a residential home.
The Community Care Act came in the wake of a number of warnings about the high costs involved in patients staying longer in hospital than was medically necessary. A National Audit Office report in 2000 (Inpatient Admissions and Bed Management in NHS Acute Hospitals) said that in 1998-9 about 2.2 million bed days could be attributed to delays in discharge, costing the NHS £1m a day.
The authors of the new study, from University College London and the University of Edinburgh, surveyed all 150 social service departments in England about the implementation of the act and analysed trends in the number of patients whose discharge was delayed and the numbers and causes of delayed discharge bed days.
Their results showed that 62 of the 99 social service departments that took part in the survey made no payment of any kind to an acute hospital in 2004-5 and that 63 did not do so in 2005-6. Among those that did make payments, says the report, the amount paid varied enormously.
The total payments made in 2004-5 came to £4.9m. The total number of delayed discharge bed days attributed to social services in 2004-5 was 206379, and the authors calculated that if acute hospitals had charged a daily tariff of £120 (the higher amount used in the South East) they could, in theory, have gained £24.8m.
The report says that delayed discharge bed days amounted to 1.6% of all inpatient bed days in 2004-05, but the analysis shows that “contrary to popular opinion, the NHS accounted for two thirds (67%) of bed day delays.”
It says it was not possible to differentiate between delays caused by primary care trusts and those caused by hospitals but adds that delays attributed to the NHS included delays caused by “patient and/or family reasons,” “disputes between statutory agencies,” and delays to discharge of patients who are not eligible for community care funded by social services departments—delays that “are not necessarily the ‘fault' of NHS service providers.”
The report says that the long term trend towards a fall in the number of delayed discharge bed days may have accelerated briefly with the introduction of the act,act, but it adds: “A major cause of delay was patient or family reasons, which suggests that many patients are experiencing hospital discharge negatively.” They warn that speeding up discharge may have led to patients' dissatisfaction with the discharge process.
At the same time, though, numbers of readmissions have risen. The authors wrote, “There has also been a rise in the rate of emergency hospital readmissions [of patients of all ages] in England, from 5.4% in 2002/03 to about 6.7% in 2005/06. Although this might reflect changes in the age and case mix of hospital admissions, it could reflect a lowering of the thresholds for discharge.”