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Fines for social services departments brought early success in reducing bed-blocking, but the numbers are creeping ...
Fines for social services departments brought early success in reducing bed-blocking, but the numbers are creeping up again as more difficult problems - which may be a result of targets and choice - rise to the surface, reports Health Service Journal.

Bed-blocking - or delayed transfer of care - is meant to have become a thing of the past with the introduction of both fines and financial help for local authorities to transfer patients quickly.

But for many primary care trusts the problem has never gone away - and there are signs that it may be on the increase again.

Department of Health figures show that the number of patients affected in England dropped from 3,220 in December 2003 (just before fining was introduced) to 2,190 last December - a 32 per cent decrease.

However, almost all of this reduction was achieved in the first year of fining and the figures have declined only slightly since December 2004. The last three quarters' figures are all higher than in the same period the year before.

The focus four or five years ago was on reducing the delays because of social services issues, such as delays in assessing and agreeing to fund patients who needed to be in a care home. Uncomfortably, there is some evidence that the 'easy wins' from sorting out social care delays may have been delivered fairly quickly and what is left is more problematic.

Some of the remaining delays are down to social services needing to assess or place patients but the majority may now be due to other factors - a combination of NHS delays and ones related to personal choice and decisions made by patients and carers.

The Local Government Association says that delays due to social services fell by 12 per cent last year. While 60 per cent of delays were social services linked when fining was introduced, the LGA says more recent figures suggest that around two-thirds of delays are now for NHS reasons - such as patients not being able to move out of an acute bed.

LGA adviser Tim Hind says that a lot of work has been done on social care-linked delays and many have been eliminated.

'There may have people who were in hospital inappropriately,' he says. 'It appears that now that is not the case. They stay in hospital for a long time because they are extremely unwell or they are waiting for an NHS resource. The linkage with the community hospital issue may be important.'

HSJ analysis Why bed-blocking is making an unwelcome comeback

LGC Joint assessments key to co-ordination

Children & adult services

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