Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 511 - 519)




  511. Colleagues, may I welcome you to this session of the Committee and welcome our witnesses? We are very grateful for your co-operation with our inquiry and for your submissions. Could you each briefly introduce yourself and say a word or two about your own personal background and your organisation?

  (Mr Ransford) My name is John Ransford. I am Director of Education and Social Policy at the Local Government Association. I am a social worker by profession and was twice a Director of Social Services in local authorities and twice a Chief Executive in local authorities. At the Local Government Association I lead policy advice for social care amongst a range of other personal services. I should say that Councillor Rita Stringfellow, the Chair of the Social Affairs and Health Executive was expected to be here today, but she cannot attend for health reasons, so I am here in her stead.
  (Dr Morgan) I am Gill Morgan. I am Chief Executive of the NHS Confederation. The Confederation is an organisation which represents the majority of NHS organisations in all four countries. We have a whole UK remit. My background is that I am a public health physician by training. I was a Director of Public Health and latterly I ran a health authority in the South West of England before I moved to the Confederation.
  (Dr James) I am Chris James. I am a full-time GP in Southampton. I used to be Chair of a primary care group. I have just finished a year's sabbatical from clinical practice entirely to work in a local hospital trust in a modernisation team, looking at the interface between primary and secondary care. The organisation I am here to represent is the NHS Alliance, which is a membership organisation. Our members are our primary care organisations.
  (Mr Leadbetter) I am Michael Leadbetter. I am Director of Social Services for Essex and have been for nearly ten years. Prior to that I was Director of Thameside for nearly seven years. A long time before that I was the manager of a print works and I am a social worker by profession. I represent the ADSS here today as President.

  512. And an ex professional rugby league player?
  (Mr Leadbetter) Yes; I forgot that.

  513. It is very pertinent on this Committee. Whom did you play for? Oldham, was it?
  (Mr Leadbetter) Rochdale Hornets.

  514. May I begin with Dr Morgan? In your evidence you have estimated that delayed discharges result in a loss of 2.2 million bed days in the NHS each year. One of the issues we put to the Department initially was the financial cost of delayed discharges. We were unclear as to what their response was. We did not get an answer and we made certain calculations. What estimate have you made of the financial cost of this particular problem?
  (Dr Morgan) There is a number of difficulties with the figures. The first thing which is really important, which you are aware of, is that the way the figures are counted do not always count all delayed discharges. We shall come to the reason for that later; it is about community hospitals. Historically those figures for community hospitals were collected as part of the figures; you collected what was delayed in an acute hospital, what was delayed in a community hospital and you added the figures together. That was changed in terms of counting. It was right that it was changed in terms of counting because you were having the same issue. A patient waits in an acute hospital bed for a community hospital bed, so if you counted two delayed discharges you were doubling the cost to the NHS when it was actually one patient needing to move through a complex system. The 2.2 million bed days historically actually includes the beds in community hospitals as well as in the acute hospitals. It is therefore very difficult to get an exact figure because it is not just an average cost for an acute hospital bed, it includes lower cost facilities which are run within the NHS as well. We do not have an overall estimate of what the cost is. I have seen costs estimated at about £750 million, but I am not entirely sure what those are based on, because of how you count what makes up a delayed discharge and what the lost bed days are.

  515. Did you make any estimate of the cost of delayed admissions as a consequences of delayed discharges?
  (Dr Morgan) No, we have not done that.

  516. Presumably you would accept that is another issue as well.
  (Dr Morgan) It is another problem. As far as the NHS is concerned, you can only use a bed once: when there is a patient in the bed, the bed is used. You can either count the cost of delayed discharges or the cost of delayed admissions. You cannot add them together because it is one bed which has been blocked. It is how you tease out those factors, but there is no simple methodology. Even though it seems it ought to be simple, it is not, because it is both the patients coming in and patients going out at the other end.

  517. Do you think it is simply an area which ought to be quantified in some way? It is not just the impact upon the Health Service. There will be the impact upon local authority services where services will be required, intensive services in some instances, to support somebody who ought to be admitted to hospital.
  (Dr Morgan) Yes, we would. One of the strong views which has come through from our members in preparing for today is that they believe that just counting delayed discharges, the percentage or the number of delayed discharges, without counting the bed days as well does not fairly represent what is really going on in the system. You could have a person counted as a delayed discharge who waits one day; on the other hand you could have a person as a delayed discharge who waits six months. They are fundamentally different in how they impact on the running of the system, but as we collect the data today they both appear as equal in the weighting we give them. We should like to move to something which actually looks at the days lost, rather than the numbers of blocked beds. That does not reflect what is actually going on.

  518. Mr Ransford, may I come to you? In your evidence you imply that the issue of delayed discharges has been exaggerated. Do you want to say why you feel that is the case or have we misread your evidence?
  (Mr Ransford) It certainly needs to be got into proportion. We see the hospital admission of a person as a very important part of their care journey. The acute part of their treatment needs to be targeted at the people who need it most. You have to look at the whole needs of the individual and the system which supports them. The delayed discharge issue is usually typified in terms of the system not working. Something has gone wrong in where that person is going, so the bed is blocked—to use the popular term. There are all sorts of reasons why delayed discharges can occur and we must never forget that part of that is the choice of the individual. Certainly if the person is going into residential care there is a direction about choice.

  519. We shall be going into that later on.
  (Mr Ransford) We need to typify what a delayed discharge means. The whole thrust of our evidence and the local authority view of this is that if we have a robust pattern of community services, properly resourced, with sufficient capacity to meet people's needs, the hospital issue and the whole notion of acute treatment, can be got in the right proportion. We do not have that right proportion now.

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