Published: 09/05/2002, Volume II2, No. 5804 Page 17
At least no-one could accuse the government of a lack of confidence. 'By 2004, we will end widespread bed blocking, ' the NHS plan announced in July 2000. It is a bold aim and, if achieved, will denote that effective joint working between the NHS and social services has become the norm. But it would be a mistake to underestimate the scope and complexity of the task.
Few issues test the efficiency and sensitivity of the whole system more consistently than elderly people being admitted to hospital, often as emergencies, and then finding their care journey stalled because of the lack of alternative provision. The capacity available to social services then becomes a key issue. The number of residential and nursing home beds has fallen in the past decade, with a drop of more than 12,000 places last year. And the closure of a single home can have a dramatic effect on the local system, irrespective of social services' readiness to place people. There is still a shortage of intermediate care provision and new services cannot be developed overnight, even with the 6 per cent increase in funding promised in the Budget.
Now the government has acted on the recommendation of the Wanless report and proposes to charge social service departments the costs of keeping older people in hospital when they no longer need to be there. What effect this will have on the very mixed economy of care for the elderly, where gazumping for places is not unknown (see features, page 22-27), is far from clear.
The experience of Sweden (news focus, pages 10-12), which introduced crosscharging 10 years ago, may offer hope to those primarily concerned with throughput, coinciding, as it has, with a halving of hospital beds. But it must also raise concerns about patient satisfaction and quality of care. Even the architect of the system, Gert Alaby, admits that very sick patients have sometimes been forced to leave hospital. And a decade on, the fate of those with only a few days to live is still being discussed.
Some in the UK care homes sector have warned that fining local authorities will not help those already short of funds and the British Medical Association, while welcoming incentives to speed up the discharge of patients well enough to leave, hopes relationships between hospitals and councils will not become fraught due to the threat of financial penalties. Given these concerns, the comparative sums dished out to the health and social services sectors in last month's Budget look a little unbalanced.
The government may achieve its target and the patient journey may be a good deal quicker, but both can expect some bumps along the way.