Waiting Time for Discharge From Hospital
Dr Andrew Murrison (Westbury, Conservative)
I beg to move,
That leave be given to bring in a Bill to provide an upper limit on the time that a person who is ready in all respects for discharge must wait before leaving an acute hospital.
"bed blocking is probably the most urgent problem that we face in the national health service."—[Hansard, 4 July 2001; Vol. 371, c. 259.]
According to the latest figures available—I have just been sent them—bed blocking has not got any better, nor has it stayed the same; it has got worse. Rather like Robespierre, the Prime Minister sees a wrecker around every street corner. His remarks on wrecking completely mystified those of us who have worked in the public services.
My Bill is constructive, for it deals with a situation that touches the lives of so many constituents as patients, carers and members of the caring professions. It sets a standard to which I believe no Government or no hon. Member could reasonably object.
"Bed blocker" is a horrible, pejorative term, but it has something of an advantage over the alternative term, delayed discharge, because it conveys something of the awfulness of what is going on.
The national beds inquiry found:
"At least two out of every 10 days spent by people aged over 65 in acute hospital beds could be better provided in alternative facilities such as intermediate care beds."
But all health statistics come with a health warning these days, for there are as many ways of tweaking the figures as there are hon. Members. Some bright spark recently realised that if the wheels were taken off a hospital trolley, it became a hospital bed and there were no more trolley waits. So it is better, then, to rely on the press. Indeed, it is thanks to the Daily Mail that the Government had to concede in October that, during the year, there had been more than 680,000 elderly bed blockers.
Our dear old friend the postcode lottery pops up to produce a huge disparity across the country and even between localities served by individual trusts. For example, the Royal United hospital, Bath, finds it more difficult to discharge my constituents than it does to discharge people from other districts. People wait to get out, so people have to wait to get in. The Prime Minister was forced to admit during last week's questions that the number of operations that had been cancelled has risen substantially since 1997, and it now emerges that that number has risen as a proportion of operations performed.
Last week, a London consultant told me that bed blocking was so bad in his hospital that patients regularly have to sleep on the floor. In the 21st century in Britain, patients are sleeping on hospital floors. Those of us with first-hand experience as in-patients will know full well that life on a hospital ward is unsettling whether or not people are fortunate enough to have a bed—for the elderly, that would be a gross understatement.
Hospitals cannot always cure people; they cannot always make them feel much better, but at least they can ensure that they do them no harm. Busy hospitals are dangerous, profoundly unsatisfactory places for elderly patients to be for a moment longer than is absolutely necessary. The consequences of delayed discharge—hospital-acquired infection, deep vein thrombosis and bed sores—may seem like small beer to the fit and healthy specimens in the Chamber, but they represent the grim reaper for many debilitated patients.
The Government will say that they are working hard to tackle bed blocking, but before we get too excited about increased funding, we should note that the King's Fund thinks that activity has actually declined, and the reason, very largely, is that the system is all blocked up. In response, the Government have tipped a wheelbarrow of extra cash on to social services, but the National Care Homes Association has said that that money represents little more than a sticking plaster.
The Health Act 1999 made my Bill possible. My cue lies with the increased flexibility as between health and social services that it introduced, but experience from Northern Ireland suggests that it is unlikely that the joint working arrangements that the Act encourages will alone magic away bed blocking. Funding increases for the national health service have far outstripped social services. Logically, that should drive up in-patient activity, but what happens downstream? The balance is clearly wrong, as the King's Fund has pointed out.
The bed blocking Bill would make two assumptions: first, that patients who are ready for discharge are better off supported in their own homes or in homely settings in the community; and secondly, that insufficient community care and support is the greatest single impediment to timely discharge. The Bill would facilitate a model based on the Swedish approach to delayed discharges. That hugely successful innovation provides for cash transfers and penalties between agencies to achieve bed blocking targets.
Bed blocking is not just the result of finite resources; it is the result of the resources being used inappropriately. My hon. Friend Mr. Burns revealed that it costs £1,630 to have someone in hospital for a week and £319 for a week in a care home. Where is the sense in that?
The wait for admission is resource dependent, but the wait for discharge need not be, and both would be eased by a Bill that sets a maximum wait beyond an agreed discharge date. The date would be agreed by the relevant agencies on a case-by-case basis and would be supported by the cross-transfer of funds. This is such a reasonable measure that hon. Members who seek to wreck it will have a great deal of explaining to do in their constituencies, and I am very sure that there are no wreckers in this place. I ask the House to support my bed blocking Bill.
Question put and agreed to.