Page last updated at 05:17 GMT, Wednesday, 19 August 2009 06:17 UK

'Joint account' would help free NHS beds

Andrew Whitehouse
By Dr Andrew Whitehouse
Consultant physician, West Midlands

Elderly man in hospital
Elderly people have to remain in hospital until social care is arranged

Bed-blocking is an ongoing problem for the health service, with elderly patients stuck in hospital waiting for their long-term care to be arranged.

In this week's Scrubbing Up health column, Dr Andrew Whitehouse says the answer is to merge health and social services budgets - so elderly people get more streamlined care.

Why do we waste so much money treating our elderly so badly?

Every time I do my ward rounds I find, like other physicians, that roughly a third of my patients do not need to be in hospital.

We deal with the medical and rehabilitation needs of our elderly rather efficiently and we agree the way forward with the patient and her relatives.

When discharge is prescribed, we advise the social services department of any care needs the patient has.

It costs about £700 a day to keep a patient in hospital, and about £700 a week for a decent full-time nursing home placement

This may be for a home care visitor package to assist dressing or washing. It may be for residential or nursing home placement.

Then the wait begins.

The social services department has its own procedures for deciding on what, when and how to deliver, and of course we comply with these procedures diligently and promptly.

Indeed we begin to think about the plan for discharge at the point of admission.

But despite this cooperation long delays are routine; delays which dreadfully distress the elderly and their families for whom these may be precious last months or years, delays which result in hospital acquired infections and depression, and which mean the beds cannot be used for those who really should be in hospital.

So why is this?

Endless 'liaison'

Well it's very simple. When people are in hospital the NHS pays. After discharge social services pays.

The two departments work to different masters.

The Department of Health controls the health service and its budget, and the county or city councils control social services departments and their budgets.

Each manages its money independently of the other.

There is plenty of "joint working" and endless "liaison" to help us to "work closely together".

It's all political

There has even been a scheme for hospital trusts to fine social services for any avoidable delays in discharge, but with no discernable impact on the speed of discharge.

And just to be clear; it costs about £700 a day to keep a patient in hospital, and about £700 a week for a decent full-time nursing home placement, far less for residential care and less still for a package of home care.

So what can be done?

The solution is perfectly obvious to anyone who thinks about it - merge the health and social services budgets.

Give responsibility for elderly people's care funding to one body.

'Insane split'

Let the home care, and residential and nursing home funding provider also be responsible for managing the health care budget, and just see how quickly the new budget holder arranges for discharge, and takes advantage of the savings available!

The patients and their families would be delighted by the prompt service, hospital staff and beds would be used efficiently, hospital acquired infection rates would plummet, cold surgical admissions would proceed without last minute cancellations and many hospital wards could be closed, and "liaison officers" dispensed with, to vast financial saving.

So why not? Why hasn't it been done already, if it's so obvious?

Well, I guess it's all political. The Department of Health belongs to Westminster, social services departments belong to local government.

The Westminster politicians need to keep their local politicians happy, and to remove their big social care budgets might upset them.

In that case why not give them the whole lot? Why not devolve health care budgets to local government too?

Perhaps because central government seems to want to control the NHS, and might fear the loss of this great empire.

So this insane split will continue.

My elderly inpatients will languish on in hospital, desperate for discharge for their last few years, healthcare staff will bemoan this continuing and painful inefficiency, taxpayers' money will gush down the drain - until we get a visionary leader who can sort it.

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