Delayed Discharges

– in the Scottish Parliament at on 10 February 2011.

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Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

The next item of business is a statement by Nicola Sturgeon on delayed discharges. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I am happy to make a statement today on delayed discharges.

I intend to cover three issues. First, I will address the issue that has attracted recent media coverage: patients who have died in hospital after having been deemed clinically fit for discharge. Secondly, I will cover the action that has been taken to address recent difficulties in Fife—a matter that has also attracted local media coverage and which has been raised previously in the chamber by local members. Thirdly, and more generally, I will detail the very significant progress that this Government has made in reducing delayed discharges.

I turn to the issue of patients who have died in hospital after having been deemed fit for discharge. First, I offer my sincere condolences to anyone who has lost a relative in those circumstances.

I am sure that all members will agree that, tragic and unacceptable though such situations always are, it is neither possible nor appropriate to presume certain conclusions. For example, it cannot be presumed that a patient would not have died had they been at home rather than in hospital, nor can it be assumed that, at the precise time of someone’s death, hospital was not in fact the best place for them to be. All of that will, of course, depend on the circumstances of an individual case.

However, we can say with certainty that we have a duty to enable older people to stay at home and live independently for as long as possible. We also have a duty to enable them, when clinically fit to do so, to return to an appropriate homely setting after a stay in hospital.

Therefore, in my view, in order to underline how important it is to avoid such situations arising—and to ensure that the focus remains at all times on reducing delayed discharges—when a patient has been deemed fit for discharge and subsequently dies before discharge takes place, the medical director of the relevant national health service board should ensure that the circumstances are always fully reviewed. I have written to boards advising them that that should be the practice and that I expect them, as part of their clinical governance arrangements, to receive regular updates. In Fife, where a freedom of information request revealed that 93 patients had died after being judged fit for discharge in 2010, the medical director is already reviewing the circumstances of all the cases.

The second issue that I want to address is the general issue of delayed discharges in Fife and the problems experienced in recent times. The level of delayed discharges in Fife towards the end of last year was unacceptably high. Shona Robison discussed the situation with the health board chair and the leader of Fife Council on a number of occasions, and she met them on 20 January. At that meeting, NHS Fife and Fife Council confirmed that they had contributed equally to a £500,000 fund to provide additional resources to address the problem. In addition, the council committed to sustaining its core care management budget, which would be sufficient to make 45 care home placements each month. Assurances were given that by the end of February all those delayed at the time of the meeting would have an agreed care package in place. Following the meeting, local MSPs were fully briefed.

Since then, those patients have started to be discharged, and I fully expect the partnership to be back on track by the end of this month. The board chair and council leader are meeting weekly to ensure that progress is sustained. The partners remain committed to and focused on—at both strategic and operational levels—addressing the challenges that they face, and Shona Robison and I will continue to monitor the situation closely.

The third issue is the general issue of delayed discharges and the progress that has been made since this Government took office. The target that we work to is that no patient should be inappropriately delayed for longer than six weeks. It is a target that was set, but not met, by the previous Government. In the last three years of the previous Government, the figures for people delayed for more than six weeks at the April census dates were 636 in 2005; 498 in 2006; and 233 in 2007.

In each of the three years in which this Government has been responsible, the figures at the April census dates have been zero in 2008; zero in 2009; and zero in 2010. Indeed, Richard Simpson said in this chamber on 25 June 2009 that:

“The reduction from 2,000 ... to zero ... is excellent”.—[Official Report, 25 June 2009; c 18935.]

The figure of 2,000 that he referred to is from September 2000, when 1,944 patients were delayed for more than six weeks. The minister responsible at that time was Iain Gray.

Of course, members will say—rightly—that the April census figures do not tell the whole story and that what happens between those dates also matters. I agree with that. The latest figure that we have available is from October last year and, at that time, there were 128 patients delayed for more than six weeks. Let me be absolutely clear: that figure was far too high and we must do better than that. Again, however, it is reasonable to point out the direction of travel. At the same stage under the previous Administration—in October 2006—the figure was 679, more than five times higher.

Yes, we have work to do. Our aim must be to ensure that no one breaches the six-week target at any time. In my view, we should also be looking to reduce the six-week target to less than that—something that will be a priority for this Government if we are re-elected. Elderly people have a right to enjoy their later years at home where possible, with the support that they require to live as independently as possible. We still have work to do, but we are making progress—progress for which NHS boards and local authorities deserve credit.

Those who say, or imply, that the problem of delayed discharges is worse under this Government than under the previous Government are simply wrong. It is not worse; it is significantly better. Those who say that delayed discharges are higher because social care budgets have been cut under this Government are doubly wrong. Repeatedly in past weeks, and as recently as yesterday, Jackie Baillie has claimed in this chamber that the social care budget has reduced by £400 million. She cites Audit Scotland figures and compares a figure of £3.2 billion in 2007-08 with one of £2.8 billion in 2009-10. However, what Audit Scotland has confirmed—and it has now amended the relevant document to make this clear—is that the 2007-08 figure is gross expenditure and the 2009-10 figure is net expenditure. It is simply not legitimate to compare those two figures, and Jackie Baillie’s assertion that there has been a cut in the social care budget is false.

The accurate figures can be drawn from other Audit Scotland documents—the overview of local government in Scotland reports. The 2008 report shows social work spend in 2007-08 as £3.3 billion, and the 2010 report shows social work spending in 2009-10 as £3.7 billion—in other words, not a £400 million cut but a £400 million increase.

I have written to Jackie Baillie today to set out those facts. I therefore trust that the false assertion that she has repeatedly made about social care funding—while I accept that it might be the result of an honest error—will not be repeated.

Reducing delayed discharges is a priority for this Government, and as long as one elderly person finds themselves delayed in hospital for a day longer than they need to be, we will know that we have more work to do. However, we have made progress and I believe that that should be acknowledged.

If we are to reach a stage when delayed discharges are eradicated for good—not just those over six weeks—we need to do things differently and better in future.

Reshaping care for older people is a key piece of work that is driving change in care and support for older people and end-of-life care. However, the financial climate that we live in and the fact that it is the right thing to do means that we must pick up the pace of change. That is exactly why this Government has established the change fund—a £70 million fund for older people’s services, which is to be used not to plug gaps left in budgets as a result of Westminster cuts but to enable and support radical changes to the way that services are provided across health and social care. That is why we, like others in this chamber—I hope that this is a point on which we can reach consensus—believe that a single system that integrates health and social care is needed.

I very much look forward to continuing to debate these issues in the months ahead as we maintain a firm focus on reducing delayed discharges and as we all live up to the responsibilities that we owe to all our older people.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

The cabinet secretary will now take questions on the issues raised in her statement. There will be about 20 minutes for that process.

Photo of Jackie Baillie Jackie Baillie Labour

Like the cabinet secretary, I, too, send my condolences to the families affected. I thank her for an advance copy of her statement.

I found it disappointing that the cabinet secretary used the majority of her time to attack the Opposition, rather than shining a light on the scandal of people dying, perhaps unnecessarily, while awaiting discharge from hospital.

I think that we would all agree that the situation in Fife is deeply concerning. As recently as three weeks ago, there were 156 delayed discharges; 61 of those cases were waiting more than six weeks. Each of those statistics represents a person. We discovered that in the past year in Fife alone, 93 people died in hospital while awaiting discharge—that figure has almost doubled in the past two years. Let us be clear: all those 93 were deemed medically fit for discharge—clinicians said that they should not have been in hospital because they did not need to be there. Does the cabinet secretary have any more information as to the circumstances of the 93 people who died?

Many other health boards claim not to record the information, but we believe that Fife could be the tip of the iceberg. Can the cabinet secretary tell us whether this is a problem in other Scottish health boards? Will she as a matter of urgency publish data for all Scottish health boards on people who have died in hospital when they were deemed medically fit to leave hospital but remained there waiting for a care package?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I said clearly in my statement that the situation at the end of last year in Fife was unacceptable. I outlined the action that Fife Council and NHS Fife have taken and the action that Shona Robison and I are taking to continue to monitor the situation.

I also said clearly that it is unacceptable for anybody who has been deemed fit for discharge to remain in hospital and to die there. However, the idea that that is something that has simply happened under this Administration, when the numbers of delayed discharges were much higher under the previous Administration, is somewhat incredible. Jackie Baillie should reflect on that.

I cannot give Jackie Baillie information about the circumstances of the 93 patients in Fife, because, as I said in my statement, the medical director of NHS Fife is reviewing those cases. The fact that I have asked all medical directors to ensure that there is full review of any such cases suggests how seriously I take the issue. I hope that Jackie Baillie will be reassured by those comments.

I did not attack the Opposition—I simply pointed out a few facts. They may be inconvenient facts for the Opposition, but they are facts nevertheless.

Fact 1 is that the number of delayed discharges was significantly higher under the previous Administration than it is now. It is not low enough, and I want to get it lower, but let us acknowledge the direction of travel.

Fact 2 is that in recent times Jackie Baillie has been peddling the assertion that social work budgets have been cut by £400 million. Audit Scotland has clarified the point. I am disappointed that today Jackie Baillie did not have the good grace to acknowledge that, for whatever reason, the assertion that she has made in the chamber is false. She should do that. In the meantime, as the Cabinet Secretary for Health and Wellbeing, I will continue the important and serious work of reducing even further the number of delayed discharges. I ask the Opposition to stop playing politics with the issue.

Photo of Murdo Fraser Murdo Fraser Conservative

I thank the cabinet secretary for her statement and for providing me with advance sight of it, although I intrude with some trepidation on what appears to be a private conversation between the cabinet secretary and Jackie Baillie.

First, as a local member, I welcome the focus on Fife. I am grateful to ministers for their updates on the situation there. To put it politely, there seems to have been a breakdown in communication between Fife Council and NHS Fife. That situation has now been resolved. What assurances can ministers give us that it will not be repeated in the future?

Secondly, I agree with the cabinet secretary that integration of health and social care budgets would help to reduce the problem of delayed discharge. What is her proposed timetable for that much-needed change, for which the Conservatives have called for some years?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Towards the end of last year, things did not go as they should have in Fife. I am not here to attribute blame in either direction between the health board and the council. However, we have made absolutely clear to both that they have a duty to work together in the interests of older people. In my statement, I outlined the financial and other action that the board and the council have taken. It is my responsibility, as the Cabinet Secretary for Health and Wellbeing, and that of Shona Robison, as the Minister for Public Health, to monitor such action to ensure that the progress that the board and the council have started to make continues and that they do not go back to the situation that existed at the end of last year.

On Murdo Fraser’s wider question, the situation in Fife demonstrates the need for single-system working. It is good that, whatever else may divide us, we now have unanimity—or as near to unanimity as we ever get in the chamber—on that issue. We may have different views on how to achieve single-system working, but I hope that over the next period we can focus more on the ends than on the means. If we ensure that implementation is done properly, our preferred model of lead commissioning, which is about to be piloted in the Highlands and is already successful in parts of England, could produce an integrated system within two years—which is much more quickly than a system involving primary legislation. We will continue to look carefully at the issue. I hope that, whatever the make-up of the Parliament after the election, we will find the unanimity to move forward in that way, because it is the right thing to do to improve outcomes for older people.

Photo of Jamie Stone Jamie Stone Liberal Democrat

I, too, thank the cabinet secretary for providing me with an advance copy of her statement. On behalf of my party, I join others in expressing our condolences to the families that have been affected.

My party recognises that in recent years there has been an improvement in the number of delayed discharges. However, the number is increasing again, with significantly more delayed discharges at the previous census than at the same time the previous year. There is no point in protecting the health budget if patients end up languishing in expensive hospital beds for weeks on end. The question is, whose foot has come off the pedal, and why is the issue not being tackled as a top priority?

We need the barriers between hospital care and community care to be broken down, but that must be done in a way that reflects local circumstances. Much has been said on the topic in recent weeks.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

You have already had a minute to do so.

Photo of Jamie Stone Jamie Stone Liberal Democrat

Does the cabinet secretary agree that, in meeting that challenge, local people and authorities, not Government ministers, should be able to determine what is good for their area? I am talking about localism.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I believe in localism, but I also believe that older people, regardless of where they live, have a right to expect certain standards of care. That is why the status quo in the delivery of health and social care services should not be defended and we should consider how to improve it.

I am glad that Jamie Stone recognised the improvement, as it is right for him to do that. I assure him that the issue has been tackled as a top priority throughout the Government’s term of office. He is also right to point out that, based on the most recent census, the figures are too high. I said that expressly in my statement. That is why we will continue to work with local partners to drive down the numbers.

On funding, it is absolutely right to protect the NHS budget, but that is not all that we have done. As I said in my statement, we have also established the change fund, which is specifically for health and social care to work together on more radical solutions for the future. That is the right way to go, pending full integration of systems in future.

Photo of Michael Matheson Michael Matheson Scottish National Party

The cabinet secretary referred in her statement to the general trend of strong progress that the Government has made in tackling delayed discharges. I, too, remember the time under Labour when more than 2,000 people were waiting six weeks or more for a discharge. I bring to her attention information that has become available in the past hour that the SNP-Lib Dem budget in Fife Council includes £4 million of additional social work spending to go towards adult care to help with progress on delayed discharges. Interestingly, the Labour group on Fife Council today voted against that extra £4 million and proposed an alternative budget that has no additional money for social work.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Can we get to the question, Mr Matheson?

Photo of Michael Matheson Michael Matheson Scottish National Party

Does the cabinet secretary agree that that is yet further evidence of the false outrage from the Labour Party and that it demonstrates the hypocrisy that lies at that party’s heart?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I am aware of that information from Fife, which, if accurate, suggests that the SNP-Lib Dem budget proposed £4 million additional spending for social work, part of which would be used in adult care to continue the good progress that has been made on tackling delayed discharges. Unfortunately, according to the information that I have, Labour voted against that and supported an alternative budget with no new money for social work.

Not only has it been revealed in the chamber today that the information that Jackie Baillie has put forward repeatedly about a cut in social work budgets is wrong, but we have found that, although Labour members profess concern about the problem of delayed discharges—I believe that their concern is genuine, because it is shared by all members—they do not tell us that their colleagues across the country are voting against additional resources that would help to tackle the problem. Let us all say that we will continue the progress that has been made and work consensually to ensure that we provide the right standard of service for our older people.

Photo of Richard Simpson Richard Simpson Labour

I deeply regret the tone in which the cabinet secretary has addressed this serious problem. We at least have transparent data from Fife. We have information on other reasons for removal from the database—which can include death—from only six boards, but that amounts to a further 100 or more patients, many of whom may have died, although we do not know. In addition to the issue of deaths, we have the separate issue of readmissions. When will the cabinet secretary ask the right questions of the boards so that we have clear data? I include in that the issue of people who are waiting for beds and who do not have complex needs but are reclassified as having them. The situation is a mess, but it is a mess in which people are dying, and that is the issue that we must address.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Based on the statement that I have given, nobody can be in any doubt about how seriously I treat this issue. I will tell Richard Simpson what I regret. I regret that the Labour Party seems intent on playing party politics with very serious issues that we have a collective responsibility to address not only in the Parliament but in health boards and local authorities around the country. I also regret that Labour has seen fit to peddle inaccurate information for many weeks now and on many different occasions. When it is pointed out that the information is false, Labour members do not even have the good grace to acknowledge their perhaps honest if careless errors.

Because of the action that the Government has taken, we have been able to roll out the new electronic discharge information system online—EDISON—across Scotland over the course of last year so that the information that health boards record and report on delayed discharges can be even more accurate. That is the kind of action that we are taking to ensure that we have the information that we need on the issue. Even more important is the action that the Government has taken that has reduced delayed discharges from the level that we saw under the past Administration to the level that they are at now. The number of delayed discharges is still too high, but it is much lower than it was before.

Photo of Linda Fabiani Linda Fabiani Scottish National Party

I welcome the cabinet secretary’s clarification of the Opposition’s false assumption about a £400 million budget cut. Of course, the backdrop against which that has to be seen is the Scottish Government’s commitment to protecting health spending over the next four years. Despite the rhetoric from Labour, its party leader was unequivocal in saying on “Newsnight Scotland” on 7 September last year that Labour would not ring fence the health budget. What effect would Labour’s failure to protect health spending have on the Government’s ambition to eradicate delayed discharge?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I say to Labour and everybody else that, on this, as on so many issues, actions speak louder than words. It is all very well for the Opposition to criticise the Government—it is entitled to do that on any issue—but it also has to be honest with the Scottish people about its alternative plans. We hear repeatedly from Labour criticisms of the settlement that the Government has given to the NHS—in this financial climate, I have to say that the settlement is an extremely good one—but Labour does not tell people that, if it was in power, the settlement would be less generous. Labour has not committed to protecting the health budget in the way that the Government has. By all means, let us have a robust debate, particularly on an issue that is as serious as this one, but let us do that in a spirit that brings to bear accurate facts and figures and treats the issue with the respect that it deserves.

Photo of Johann Lamont Johann Lamont Labour

I am hearing—including anecdotally—that pressures from the SNP on local government budgets are leading to decisions that result in delayed assessments and people having to stay on in hospital. Does the cabinet secretary acknowledge the evidence of the critical role of carers in preventing delayed discharges and of the absolute necessity of supporting carers to look after their loved ones at home? Does she recognise the deep anxiety of carers organisations that current care support does not meet the level of need? What steps is she taking to plug the gaps and end the postcode lottery of support for carers? Surely the situation of carers is, in itself, critical to preventing delayed discharges.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Johann Lamont and I disagree on many occasions about many different things, but she raises an important question. Carers are vital to the challenge of reducing delayed discharge. It is often the contribution of a carer that allows someone to leave hospital and go home or move to a more appropriate setting. She asked what we are doing. I point her towards the range of things that we are doing to improve support for carers. It may not be enough but, again, we are making progress on ensuring that carers get the support that they need.

The £70 million change fund is exactly in recognition of the pressure on local government budgets. The fund means that the NHS and local government can work together collaboratively; it supports radical change in the way in which services are delivered. I would have thought that all members across the chamber, including Labour members, even though they voted against the budget yesterday, could find it within themselves to support that. The budget is a good one and will begin to make the differences that we want to continue to see in the delivery of these kinds of services.

Photo of Mary Scanlon Mary Scanlon Conservative

Given that we look for high-quality services and best value for taxpayers’ money, will the cabinet secretary discuss and review with the Convention of Scottish Local Authorities council funding to council care homes, which can be up to 80 per cent more than that for care home placements in the independent and voluntary sectors? Dealing with that would enable what is a fixed budget to finance more care home places and help to reduce the number of delayed discharges.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

That issue has been raised repeatedly not just by Mary Scanlon but by many people who provide care home services. COSLA will continue to discuss that with the private care home sector. We must ensure that we have the best quality of services, regardless of their provider. We are focused on ensuring that.

Photo of Christopher Harvie Christopher Harvie Scottish National Party

In asking my question, I speak as the carer, over the worst winter that we have ever had, of two 93-year-olds who have a valuable two hours’ carer time each day. I will not ask what would have happened if I had not come back in the snow in December, which walled us in at Melrose for 10 days. I am glad that the £70 million change fund has been made available. Will the cabinet secretary outline what that will mean for my constituency, Fife, which I see by the day when I can at the moment?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The change fund is important because, as I have outlined, it will help health and social care to redesign services. Christopher Harvie asked what the fund means for Fife. Fife’s allocation from the fund next year will be just under £5 million—£4.8 million.

Photo of Alex Fergusson Alex Fergusson None

I ask for a bit of quiet in the chamber, please—other than from the cabinet secretary.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I am sure that that allocation will assist NHS Fife and Fife Council in continuing to make the progress in reducing delayed discharges that we have spoken about.

Photo of Marilyn Livingstone Marilyn Livingstone Labour

The cabinet secretary outlined the issues that relate to delayed discharges in Fife. As she said, I have met Shona Robison and NHS Fife’s medical director and acute services chair to discuss delayed discharges and the wider community care agenda. I hope that the cabinet secretary believes and understands my genuine concern for families and the 93 patients who died before they could be discharged. As has been said today, each of those cases is a tragedy for the family involved.

I have had representations from NHS Fife staff about the experience on the ground, which is that bedblocking is causing a catastrophe in our health service. Patients are waiting up to 19 hours in accident and emergency for a bed. They are not being treated in the most appropriate environment, which is putting their lives at risk—NHS Fife officials have said that to me. Boarding out to surgical wards has caused operations to be cancelled.

Photo of Alex Fergusson Alex Fergusson None

Could we have a question, please?

Photo of Marilyn Livingstone Marilyn Livingstone Labour

Will the cabinet secretary and the Minister for Public Health and Sport urgently ask Fife Council to work in co-operation with NHS Fife to sort out the problem now, which is affecting people in my constituency today?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I appreciate the way in which Marilyn Livingstone raises issues. She has raised several health matters in Fife with me and she has always done so extremely responsibly.

I outlined in my statement the progress that Fife Council and NHS Fife have made to begin to get to grips with the problem. I repeat that Shona Robison and I will monitor that carefully. Marilyn Livingstone is right to point out the impact on the health service of delayed discharges—I am sure that she appreciates that that term is better than bedblocking, which suggests that the fault somehow lies with individuals—but the impact with which we should be concerned is that on individuals. That is why, regardless of party, all of us in the Parliament should focus absolutely on continuing the progress that we have made to reduce delayed discharges.

Photo of Helen Eadie Helen Eadie Labour

The issue is desperately serious for everyone in the Parliament. The cabinet secretary said that the latest figure that she had—128 delayed discharges—was from October and she said that the trend was downwards, but I can tell her that our latest figure, which is from 15 January, is 156 delayed discharges.

I have always campaigned seriously on the issue. I took exception when Shona Robison accused me of “scaremongering” on 24 January 2008—that is in the Official Report.

Photo of Alex Fergusson Alex Fergusson None

I must press you for a question, please.

Photo of Helen Eadie Helen Eadie Labour

We have had this every year. What more will the cabinet secretary do to ensure that the trend is downwards? What is coming from her directorates at the moment is just not credible.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

As I am sure Helen Eadie is aware, the last official statistics that are available are from October, and the rules mean that ministers are able to quote those national statistics. I am well aware of the trends in Fife and elsewhere, which is why we are taking the action that was outlined in my statement—action that is having and will continue to have an impact in Fife.

I am sure that Helen Eadie will be as concerned as I am about the news that has been relayed to the chamber this afternoon about votes in Fife Council. The Scottish National Party’s budget proposes £4 million extra for social work, and Labour voted against that. I ask all members of the Parliament to continue to bring their concerns about delayed discharges to me and to the chamber, and also to relay those concerns to their colleagues locally, so that the actions of local members match up to their words in the chamber.