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Last Updated: Friday, 2 January, 2004, 08:42 GMT
Warning over bed-blocking fines
Patient
Delays in placing old people leads to "bed blocking"
Fines to reduce "bed-blocking" in hospitals could mean elderly patients are forced into care homes miles from their families, researchers warn.

From January, social services have two days to find a place for someone ready to be discharged or face a 100 fine.

The measure is designed to free up beds at hospitals in England and Wales for the sick and reduce waiting lists.

However, researchers at University College London said the elderly would have no choice over where they went.

A report by the Public Accounts Committee in September said that an "intolerable" number of older patients were waiting too long to be discharged from hospital.

New financial incentives could see the chronically ill and older patients being forced into accommodation which is inappropriate
David Rowland and Allyson Pollock
The report estimated it was costing the NHS 170m a year.

The MPs said that on any given day, around 3,500 older people remained in hospital in England after they had been declared fit to leave because arrangements had not been made for them to move on.

This situation is known as "bed blocking".

Individual choices

Now social services will be fined if they do not move well enough patients on within two days.

David Rowland and Allyson Pollock of UCL said this contradicted the government's pledge to give "genuine individual choices" about when, where and how they were treated.

Writing in the British Medical Journal, they said reduced NHS and social services capacity and financial incentives could see the chronically ill and older patients being forced into inappropriate accommodation.

"If their first choice of care home is not available, older patients will be offered an interim placement, which may be far away from their family ... and inappropriate to their care needs."

Ms Pollock told BBC Radio 4's Today programme: "This legislation is targeting really vulnerable people and placing them at greater risk."

She warned it would not only shift the risk and costs from the NHS to social services but also to individuals and their carers.

Safety of patients

Patients exercising their right to choose a home are said to account for 8% of all delayed discharges from hospital, they said.

They said that meant choice was seen as an obstacle to the efficient functioning of the system.

From 2006, new financial arrangements will also mean that hospitals make a loss if they continue to care for a patient longer than average.

Tony Hunter, vice president of the Association of Directors of Social Services, said the new fines made it all the more urgent to tackle an issue that had been a concern for years.

But he told the BBC: "I think we are well poised to do everything we can to maintain improvements of recent years in getting people out of hospital safely and promptly."

He said social services departments would have to attempt to anticipate likely fines for delayed discharges and provide short term care places for elderly patients while plans were made for their care in the long term.

A Department of Health spokeswoman said they wanted to guarantee greater choice for older people over the services they received.

"Hospitals have a responsibility to ensure that patients are discharged safely, if they discharge patients too early, it will face the risk that the patient will be readmitted, which will not benefit the patient or the hospital," she said.

Liberal Democrat health spokesman Paul Burstow said: "Elderly people become the victims of a game of pass the parcel between the NHS and social services when they are at their most vulnerable.

"Instead of having the ludicrous situation where the government passes money to social services on the one hand and takes it away through arbitrary fines, patients would benefit by having the money going directly to the front line."


WATCH AND LISTEN
The BBC's Vicki Young
"The new regulations could be bad news for the chronically ill"



SEE ALSO:
Q&A: Bed-blocking
17 Sep 03  |  Health
Bed-blocking: a fine approach?
02 Jan 04  |  Health
Grant to cut 'bed-blocking'
06 Oct 03  |  Kent


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