Examination of Witnesses (Questions 511
WEDNESDAY 8 MAY 2002
MR J RANSFORD
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
(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
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 blockedto 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.