What Are Councils Doing About Bed-Blocking?

Among the many reasons given for the ongoing high number of delayed transfers of care – which has resulted in problems getting patients into as well as out of hospital – has been the lack of care home places in the community.

But it was also apparent that the whole system is not equipped to deal with the ageing population and the subsequent demand for acute hospital beds, rehabilitation places and long-term residential and nursing home care.

In the second part of the Health Wales focus on bed blocking, we asked the two local authorities within Cardiff and Vale NHS Trust’s main catchment area and care home owners where they feel the solution lies.

Mario Kreft is chief executive of Care Forum Wales, an umbrella organisation which represents the independent care sector in Wales. He said: “The issue of bed blocking, or delayed transfer of care as it is referred to by the industry, is well recognised as a problem throughout Wales.

“Indeed, it is creating such problems that Care Forum Wales has developed a full-scale study of the problem in Cardiff and the Vale of Glamorgan, which has been presented to the Wales Audit Office. The study highlights the causes and effects of the issue and seeks to identify possible solutions.

“As the main membership body representing the care sector in Wales, Care Forum Wales has identified four main factors which are exacerbating the problem of bed-blocking. These are lack of provision in care homes of choice, low provision of beds, lack of local authority funding and finally families prevaricating over choice of care home.

“By far the most serious concern is the shortfall in capacity, which has led to higher occupancy levels in care homes. Where homes offer good standards of care and are a popular choice for patients long waiting lists of potential clients have developed. The loss of capacity has also led to fewer homes serving local communities and, where choice is very limited, long waiting lists have developed for the homes serving that community, or else face placing a loved one in a home out of their area.

“With an ageing population, it seems common sense that provision in care homes should be increased, not reduced. However with the current issues surrounding funding for private sector care homes this is becoming an impossible task for many care home owners. What should also be acknowledged is the need to take into account the opportunities afforded by domiciliary care providers – not every individual leaving hospital requires a care home bed. Many want to be cared for in their own home and this would be the ideal solution.

“The way forward has to be realistic funding provision for care homes and the domiciliary providers earmarked from central government budgets. There also has to be a real commitment to partnership working between the Welsh Assembly Government, local authorities and those in the private care sector.

“It is widely recognised that the creation of Local Independent Sector Provider Forums would alleviate the difficulties and help the sector move forward. Bed-blocking is a real problem in hospitals but, in reality, it is also a very unsettling and worrying time for those who need care and their families.

“It is the people behind the statistics who are the story and we have an obligation at Care Forum Wales to ensure our members are in the position to provide high- quality care to those who need it when they need it.”

A statement from Vale of Glamorgan Council said, “Much progress has been made in the Vale of Glamorgan in recent months on the challenging issue of delayed transfers of care. The Vale of Glamorgan Council, Vale of Glamorgan Local Health Board and Cardiff and Vale NHS Trust have worked closely together to alleviate some of the pressures in the system and improve the outcomes for patients and their families.”

Mark Wheeler, interim social services director for the council, said the factors which contributed to bed-blocking were often multiple and complex. He said, “Delays in hospital discharge can occur for a variety of reasons, often when patients’ needs are complex and require specialist support, which may not be readily available. Many of the current delays are down to the necessity to meet patient and family choices.

“In recent months, delays for social care reasons have reduced significantly and it is reassuring to see an overall reduction, which is in no small part a result of improved dialogue between council social services and health service partners, patients, their families and the independent sector.”

Abigail Harris, chief executive of the Vale of Glamorgan Local Health Board, added that it was only by continuing to make a concerted effort as a health and social care community that delayed transfers of care would continue to fall in the Vale of Glamorgan.

She said, “We all recognise that delayed transfers of care not only put a great strain on patients and their families, they also put pressure on the rest of the healthcare system.

“The LHB will continue to work closely with its partners to help resolve some of the short-term issues associated with delayed transfers of care, but also to look at the way forward in the longer term, to ensure we are in a position where, in the future, these problems are much less acute.”

Mrs Harris added that there is regular dialogue between the chief executives of the organisations involved with the support of the Wales Audit Office.

A statement from Cardiff Council said, “Delayed transfers of care put strain on families and health services. So we are working hard with our health partners to reduce these delays in a sensitive and sustainable way.

“Managing people’s transfer from hospital treatment to care in their own homes, in care homes, or in other health care settings is a challenge that requires partnership working at all levels – from working with individuals on their specific needs to making sure a full and balanced range of systems and resources is in place.

“We are working on two main issues. Firstly there have been delays in assessing people’s needs. So we have improved the social work service in hospitals by appointing three more staff to speed up assessment. We have also focused our home care services on helping people get home sooner.

“This work alone has led to a one-third reduction in delays for social care reasons. Secondly, there aren’t enough beds in nursing and specialist residential homes. This is the biggest issue that we face. The shortage makes it hard to place people and limits their choice. It also affects the cost of accommodation.

“So we have recently secured 10 extra places in specialist residential care homes with another 10 to come in the near future. We are also discussing creating another 20 nursing home places. But this really needs a long-term solution. We are working with our local health board colleagues on a strategy to jointly purchase nursing and specialist residential places, so increasing the supply and providing more choice.

“We have also worked with Cardiff and Vale NHS Trust to improve case management and information flow in hospitals. This is not just about numbers. Every one of the published delayed transfer of care statistics is a person with unique needs, a concerned family and the right to choose their future. We are working to improve their lives as well as improve our organisations’ performance.”