‘Bed blocking’ in Welsh hospitals – report suggests little improvement

A new report has concluded that attempts to reduce ‘bed blocking’ in Welsh hospitals have made little or no difference to the problem over the last two years.

Bed blocking occurs when inpatients who no longer need to stay in hospital have their discharge delayed, often because follow-up services for the patient are unavailable.

Among the patient groups most affected by the problem are those being treated for mental illness and elderly patients.

The Welsh Institute for Health and Social Care (WIHSC) says the NHS in Wales discharges around 500,000 people from hospital each year, of whom around 10,000 are deemed to be ‘delayed transfers of care’.

Although only accounting for 2% of all hospital discharges, the WIHSC report says “such delays are a significant problem, because they can have an adverse effect on the patient concerned, they can delay the admission of other patients with more acute needs, and they cost the NHS significant sums of money.”

WIHSC’s Independent Review of Delayed Transfers of Care in Wales, which was commissioned by the Welsh Assembly Government in June last year, says that there was an initial fall of 38% in bed blocking cases from 2003-2005.

But from 2005 to 2007, the number of delayed discharges has “essentially plateaued” at around 600 patients in a bed blocking situation around Wales at any one time.

“In other words,” the report concludes, “Wales is overall doing no better or worse by the end of 2007 than it was in 2005”.

The acting director of WIHSC, Professor Marcus Longley, said: “A radically new approach is now needed. This will require the NHS, social services, housing agencies, private providers, and the voluntary sector all working together, with support from the Welsh Assembly Government.”

The report highlighted inadequate provision of community services and residential care for those leaving hospital along with inefficiency in the management of care planning and brokerage as key factors in the problem. Multi-agency working needed to be improved into order to provide co-ordinated care for vulnerable patients, the report added.

“Services should be commissioned so that the transitions between health and social care settings and services are managed in a way that minimises delay, as part of the whole system of health and social care locally,” the report’s authors state.

“It should be noted that overall the largest total number of bed days associated with delays occurs in mental health services. The interviews conducted throughout Wales certainly confirmed that transferring people with mental health problems from hospital into other care settings was one of the most difficult components of managing delays.

“Patients with mental illness or learning disabilities can be delayed in a setting for which they no longer have a need.

“They can occupy acute or assessment psychiatric hospital capacity, or learning disabilities settings, denying these facilities to others and possibly receiving sub-optimal care.”

Welsh Assembly Government Health Minister Edwina Hart said she will consider the 46 recommendations made in the report with a view to developing a new approach to the problem.

To read or download the full report, click here.