Plea for long-term care reform

The government will have to carry out long-term reform of intermediate care if the NHS bed-blocking crisis is to end, MPs were told last week.

At a meeting of the Commons health select committee the King's Fund supported 'back of the envelope' calculations from chair David Hinchliffe that delayed discharges were costing the service around£720m a year.

Janice Robinson, director of health and social care at the fund, said: 'The development of alternatives to intermediate care has been slow.' She added: 'Yes, I have seen some excellent work which has mainly been driven by short-term winter pressures. But there is a long-term issue and what we need to see is long-term funding coming through so that we can start to plan intermediate care properly.

'Local authorities since 1993 have been driving down the cost of the prices they will pay for residential care. We are having a real capacity problem.'

Ms Robinson described it as a 'looming crisis which has really started to hit at the end of last year', particularly because money to tackle the bed-blocking problem was being 'diverted for other purposes'.

The committee was told that care should not be seen simply in terms of beds. The focus of any policy should be providing care teams to ensure that elderly people could be looked after at home.

Ms Robinson said: 'It is undoubtedly the case that there is huge pressure among hospital staff to invest in beds rather than putting money into communitycare teams and rapid-response teams. It is about having a better mix then we have at the moment.'

The committee also heard claims from Helena Herklots, head of policy at Age Concern England, that patients with the ability to pay for residential or intermediate care were being discharged more quickly, with poorer patients being forced to languish in hospital because social services could not find anywhere to place them.

UK Carers chief executive Diana Whitworth stressed that the evidence was anecdotal. The committee was told one solution was for the service to be more proactive.

Mrs Robinson said it was 'well known' that patients with respiratory problems during winter would end up needing treatment.

Through GPs it was possible not only to plan for the extra demand but treat the patients before they had to be admitted to hospital.

'It is about supporting primary care to do the outreach work and work with those individuals . GPs are not well set-up to do that.'