Better systems are needed to put a stop to bed blocking. Tom Rothwell examines the problem and what can be done to overcome it

The issue of bed blocking is a perennial bugbear for the NHS. Public agencies are letting vulnerable people down through their failure to co-ordinate activities and communicate properly. Fundamental opportunities to improve communications at the most rudimentary level are being missed by those in charge of healthcare IT provision.

The Department of Health has described bed blocking as a priority area and claims figures have fallen by over 65 per cent since 2001. But last spring, figures obtained by the Commission for Social Care Inspection revealed that numbers have increased dramatically in over 10 per cent of England's local authorities with social service responsibilities.

In 2004, an estimated 3,500 older people were remaining in hospital on any given day after they had already been declared fit to leave because of delays in discharging people. Two-thirds of beds are occupied by people over 65.

Given that many hospitals in the UK have little accurate information about the number of beds blocked each day, the problem is likely to be far worse than envisaged.

There is clearly a need for better joint working between NHS agencies and social services departments.

Searching for solutions

The government tried to address the problem with the introduction of the Community Care (Delayed Discharges) Act in 2003, which allows hospitals to charge social services departments£100+ for each day a bed is blocked due to social services.

Although some have agreed not to levy the charge to help social services invest in increased capacity, for cash-strapped trusts it must be difficult not to view the monies as a potential new revenue stream to help reduce their deficits. Wiltshire social services, for example, had to pay their trust£26,700 in such charges between April 2005 and April 2006.

But many trusts still struggle with delayed discharges. Overstretched nurses still have to follow the same time-consuming and haphazard discharge procedure, waiting for office hours to then phone or fax details through to social services, with messages going unanswered, delays ensuing from social work shift patterns and critical details such as patient mobility issues getting lost.

With no manageable process in place, how can we ever hope to control this problem?

What we need is an electronic system available around the clock which mandates key information, so nurses can at any time fill in a simple template that will not be delivered until it is complete. Both ends of the supply chain then have a clear, written record of patient needs that cannot get lost or misconstrued.

Where such systems have been introduced in England, they have led to impressive improvements in relationships between hospitals and social services and better standards of care for patients. Hospitals save costs, social services avoid hefty charges unless it can be proven that the responsibility lies with them and patients can leave hospital when they should, not when they can.