Bed blocking - what is it, and is it paralysing the NHS?

"Bed blockers": Ready to go home, still in hospital

"Bed blockers" is the somewhat derogatory term used to describe patients - most of them elderly - who are occupying a hospital bed that they don't strictly need. In almost all cases, it isn't their fault; rather, their discharge will have been delayed because the NHS hasn't completed the necessary paperwork or the local authority hasn't been able to organise the next stage of their care.  

The consequences

Not only do extra days in hospital cost the NHS time and money, but it's also suggested that patients who remain on the ward - rather than being cared for at home or in the community - might suffer for it. They could acquire an infection, for example, or develop severe bed sores.

In addition, NHS England has argued that delayed discharges are causing a backlog in A&E departments: patients arriving in A&E wait longer for treatment because there are fewer beds available elsewhere in the hospital.

The Health Select Committee has proposed that bed blocking is one of the reasons why many A&E departments are now struggling to deal with demand. There's an array of evidence to suggest that A&E departments are indeed under pressure: for example, during the first quarter of this year 64% of providers failed on at least one occasion to meet the government target of seeing 95% of patients within four hours. The government is now waiting for the results of a report into the state of emergency care at England's hospitals.

The causes

- Greater demand, fewer resources?

NHS organisations report that they are dealing with more patients, but there are fewer beds for them to occupy. The official data proves their point.

In 2001, there were just over 11 million hospital admission episodes; in 2011 this number had increased to just short of 15 million. There has also, since the late 1980s, been a steady fall in the number of hospital beds for overnight patients, at the same time as the population has increased:

Over the course of the last decade one in four hospital beds has been removed (in 2002/03 there were 183,826 beds available, while in 2012/13 there were 136,799). This is because successive governments have attempted to shift care out of hospitals and into the community. In large part this has involved moving elderly patients from long-stay wards into residential homes. 

- Social care crisis?

Although a patient may be ready to be discharged from hospital, they will often need further care. Their council is then responsible for arranging either home visits or a stay in a care home. Since 2003 there's been a system of incentives in place whereby a local authority is fined if it fails to organise care for a patient who's ready to be discharged. 

Many in the NHS have blamed local councils for the delays in discharging patients, arguing that the social care system isn't up to the task. Most local authorities, dealing with cuts to their budgets, have reduced their spend on social care at a time when demand is only rising.

Somewhat surprisingly, the government suggests that the social care system is improving the way it deals with hospital patients. Last month, the Chancellor George Osborne noted that in the space of a year "50,000 fewer bed days were lost to the NHS" (a day when a patient occupies a bed unneccessarily because adequate social care isn't available).

But while the backroom numbers suggest the situation is improving, those on the frontline are saying the opposite. In a recent NHS Confederation survey, 92% of hospital chief executives said they were seeing more delayed discharges from hospital. Meanwhile, in a King's Fund poll of funding directors, 63% said that the delays at their NHS trust has become worse over the past year.

As the Health Select Committee observed, with a generous dose of candour, "The discrepancy between the evidence of people working with patients and the formal data is striking and we find the data incredible." 

There are various possible reasons for the discrepancy. As the Kings Fund has pointed out, the data doesn't give any indication of regional variation. The national average doesn't tell us what's happening at particular NHS trusts. If the majority of hospitals are managing to transfer patients without delay, this might obscure the fact that a few hospitals have a very poor record in this area.

The Health Select Committee has now recommended that the government investigates how the data on delayed discharges is collected "in order to understand whether the available figures genuinely reflect the situation on the ground". 

UPDATE 25/07/2013

This article was updated to include the following sentences:

"In a recent NHS Confederation survey, 92% of hospital chief executives said they were seeing more delayed discharges from hospital. Meanwhile, in a King's Fund poll of funding directors, 63% said that the delays at their NHS trust has become worse over the past year."

"There are various possible reasons for the discrepancy. As the Kings Fund has pointed out, the data doesn't give any indication of regional variation. The national average doesn't tell us what's happening at particular NHS trusts. If the majority of hospitals are managing to transfer patients without delay, this might obscure the fact that a few hospitals have a very poor record in this area."

We would like to thank John Appleby, Chief Economist at the King's Fund, for bringing these points to our attention.