Moves To End Bed Blocking Are Vital

At the height of the Lothian bed blocking crisis, there were so many elderly patients with nowhere to go they could have filled every bed in St John’s Hospital. With the emergence of a booming property market in the Capital, care home owners began cashing in on megaprofits.

At the same time, the spiralling cost of new regulations aimed at improving safety and facilities in care homes forced many owners to sell up. As a result, hundreds of elderly but healthy patients were left languishing in hospital, using beds that could be put to better use.

In autumn 2004 the scale of the crisis became so severe that council leader Donald Anderson began holding fortnightly meetings to tackle the problem, amid very real fears that bed shortages would cripple the Lothian health service by winter.

Something had to be done, and it was. Delayed discharge levels began to fall, and there were smiles all around in April this year when bed blocking hit an all-time low. Just 89 patients were waiting in hospital longer than they should have been. But the smiles turned upside down earlier this month, when it became clear that figures were rising again.

By June, bed blocking had shot up by nearly 70 per cent, with 150 people stuck in hospital. Last week, the new chairman of NHS Lothian, Dr Charles Winstanley, readily admitted he was “worried” by the rise. Hospitals cannot be treated as hotels, he pointed out.

The blame has largely been laid at the city council’s door. Many of the patients were simply waiting for placement in a nursing home, while others needed their social work assessment completed – the responsibility of council workers.

With winter still ahead of us, NHS Lothian’s target of just 50 delayed discharge patients by April next year seems a distant dream at this point in time. At the height of the 2004 crisis, there were over 400 patients stuck in hospital. A “patient hotel” at the Royal Infirmary, originally for relatives to stay in, became a social care facility for 20 patients.

Two troubleshooters were appointed to tackle the problem, while the Deputy Health Minister called a crisis summit with city leaders. And perhaps most importantly, hundreds of thousands of pounds were found by both the council and NHS Lothian to purchase more care home places.

Those measures worked, but this time around, the council has warned that its health and social care department is facing a “significant increase in demand for services which is impacting on the financial position”. A massive £10 million black hole is causing headaches at the City Chambers, and budgets are likely to be cut. Dr Winstanley has warned of the dangers of cutting funding, and he is right to do so.

Scotland has an ageing population, and the effect will be more pronounced in Edinburgh than anywhere else, given that its general population is also increasing. Coupled with this, the average number of available staffed beds in the Lothians is dropping. In 1998, there were 5117 beds, but that’s now down to 4004.

This is part of a general trend to treat more people in the community, closer to their homes. The measures are designed to ensure hospitals are for the truly sick, while older people can receive the care they need in more familiar surroundings. But the downside of reducing the number of beds is that delayed discharge could prove even more problematic.

With accident and emergency waiting times at the Edinburgh Royal Infirmary nearly down to a maximum of four hours, the last thing anyone wants is queues of patients waiting for vacant beds.

So more cash for care home places needs to be found to avoid this crisis, but unfortunately, care home places do not come cheap, and many families are simply unable to offer the necessary support that elderly people need if they are to stay in their own home. In fact, many are probably quite content to see their loved ones in a hospital bed, where they know they will receive first-class care.

West Lothian Council has undoubtedly had the greatest success in tackling bed blocking. It has remained consistently at the top of national performance tables, and in June there was just one patient in the whole region stuck in hospital with nowhere to go. Midlothian had 19 delayed discharge patients, East Lothian had 18, and Edinburgh had 112.

Last year, the Scottish Executive put up £8 million to begin the roll out of “telecare” systems – panic buttons and fall alarms already successfully used in the homes of many elderly people in West Lothian – and it is vital this system comes to Edinburgh.

Arguably, the Capital, given its problems in the past, should have been involved in the scheme from the start. We will soon know if June’s delayed discharge figures were just a blip, or the start of a worrying upwards trend. But what is certain is that a bed blocking crisis will re-emerge in the Lothians if the finance starts draining away.