News: The South East may be affluent, but its bed-blocking problems are so severe that they are jeopardising service delivery across the region. Alison Moore meets the man charged with arguing a difficult case

Arguing for more resources for healthcare for one of the most affluent corners of England, where people are likely to live longer and enjoy better health than the average, is no easy task. But it is an argument that Stephen Fash, the new 'beds czar' for Surrey and Sussex, feels has to be made. Put bluntly, the area's problems with bed-blocking have become so acute that the whole delivery of NHS services has been affected.

'At the last count, there were upwards of 600 delayed transfers across Sussex and Surrey, ' he says.

'That is a good-sized district general hospital.We have a whole DGH-worth of capacity denied its primary functions of providing acute services.'

Delayed transfers alongside recruitment and retention problems are the two main inhibitors of performance in the South East. 'Something like 9 or 10 per cent of all the acute beds in the South East region are blocked by delayed transfers.Yet the South East has a significantly lower acute capacity than the rest of England.

'There is a fundamental resourcing issue which sooner or later will have to be taken on board.'

Mr Fash has been at the sharp end of this.He was chief executive of Ashford and St Peter's trust in Surrey and announced his plans to take up the six-month secondment - from which he does not expect to return - the day before the trust got its zero star rating.

Severe bed-blocking was a key factor behind the trusts's poor performance. Seven out of 12 zero-rated trusts are in South East region.

But in his new role - thought to be unique - Mr Fash is dealing with the other end of the problem. Rather than coping with patients stuck on trolleys in corridors, he is attacking some of the seemingly intractable problems of finding nursing home beds.

In Surrey, the county council will pay£400 per week to place a patient in a nursing home; the going rate for self-payers - people who fund their own bed - is between£500 and£600.

London boroughs will pay closer to this rate and sometimes place people outside the capital.

No prizes for guessing who gets the available bed.

Patients or their relations will sometimes 'top up' payments but negotiating this can take time, and meanwhile a hospital bed is still being occupied by someone who doesn't need it on medical grounds.

One of Mr Fash's immediate priorities is to identify good practice across the two counties and to ensure that it is disseminated and taken up elsewhere. This can make a difference, though it is likely to be marginal.He is working with trusts, care homes and social services departments to try to find ways forward.

'I do not know whether there is any quick and easy solution, ' he says. 'The easy answer would be to say that the extra money announced recently could be used to hike up the fee level.

'But that has all sorts of implications, not least for the clients already in place at lower levels.'

It is also expensive: Mr Fash points out that if the 20 patients who are unable to be discharged in one trust he has just visited were funded at an extra£100 a week, that would add up to£100,000 a year.

In the longer term, he hopes to tackle the problem in a number of ways. One way is developing appropriate intermediate-care facilities - not necessarily easy, given the area's recruitment difficulties, but Mr Fash suggests innovative training could help.

Intermediate care also offers hope that patients will avoid 'the spiral of dependency' whereby they leave hospital for a nursing home place, but never become independent again.

Support at home is another factor - but several schemes in Surrey and Sussex are already experiencing problems in recruitment. It is a familiar story for the health service in the South East - virtually full employment locally with jobs in the private sector paying more.

Another is encouraging sufficient private provision for nursing care. Like many other areas, Surrey and Sussex have seen many homes close and the future of others is under threat because of the investment needed to meet regulatory standards.

Small independent homes, in particular, have been converted to housing or their land sold for development.

Mr Fash suggests that the public sector could become more closely involved in building capacity within the private care home sector - health and social care staff could go into homes to help raise standards, for example.

If initiatives like this fail, the future may seem bleak.Mr Fash points out the South East has an important role in the national economy.

If public services in the area are not up to scratch, then economic growth in the whole country could be under threat.