I beg to move,
That leave be given to bring in a Bill to make provision about expediting the transfer of patients who are medically fit for discharge from acute hospitals to homely settings in the community.
I declare my interest as a doctor.
Twenty years ago, I asked 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.”—[Official Report, 12 February 2002; Vol. 380, c. 76.]
The context in 2002, as now, was severe congestion in health and social care. Bed blocking is a provocative term that I use to draw attention to the harm caused to patients and the burden on our national health service. At that time, on any given day around 6,000 beds were occupied by people who should not have been in them. Indeed, Tony Blair told the House that
“bed blocking is probably the most urgent problem that we face in the national health service.”—[Official Report, 4 July 2001; Vol. 371, c. 259.]
In November, my mother-in-law died in Salisbury’s renowned spinal unit, but Selma did not have a spinal problem. She had the general frailty and multiple comorbidities of advanced old age. Her overall management was good, in parts, but modern district general hospitals are not configured for the long-term care of the elderly or for terminal care, so a good and gentle person spent her final days in acute medicine’s bewildering freneticism, noise and clamour. It was very far from ideal. She deserved much better. I have seen much better, notably in community hospitals and intermediate care—settings that have, foolishly in my view, been deprioritised under successive Governments.
An acute hospital is no place for an elderly person who is no longer receiving active medical management. I would go further and say that our frantically busy acute units, operating in the white heat of high-tech, cutting-edge medicine, can be unsafe for them. They are in constant danger of the serious iatrogenic consequences of unnecessarily prolonged stays, including hospital-acquired infections, thrombosis, skin breakdown, mental illness and psychological distress. The care pathway must lead frail elderly people to homely settings in the community that are appropriate to their needs, without delay. That long-held conviction, and my recent family experience, has driven me, 20 years after my original Bill, to have another go.
Bed blocking is everybody’s business, because our relatively efficient health system is always running hot, with bed occupancy rates far higher than those in most comparable healthcare economies. The cost to healthcare is enormous: the cost per day of an acute medical bed far outstrips the cost of homely settings in the community, supported living at home, community hospitals or nursing homes. The charity, Marie Curie, puts the annual cost at £1.5 billion. This zero-sum gain is stoked up by an institutional conspiracy of inaction, and that is because there is a baked-in perverse incentive for cash-strapped local authorities to drag their feet when getting people out of hospitals and onto their books. Hospitals save because beds, once freed up, fill up with people requiring treatment and procedures, the costs of which are, of course, front loaded.