Forum Brief: Bed blocking

Government plans to fine "bed blocking" local councils will divert cash from care of the elderly, the Association for London Government has warned.

Forum Response: Counsel and Care

Martin Green, chief executive of Counsel and Care, told ePolitix.com: "There is a desperate need to improve discharge but I do not think that fining councils will help the situation."

Forum Response: The Stroke Association

Eoin Redahan, spokesman for the Stroke Association, told ePolitix.com: "The Stroke Association does not support the proposal to introduce a system of reimbursement around discharge from hospital.

"Stroke is a devastating condition and the needs of people affected by stroke cut across health and social care. We are concerned that the introduction of this system could lead to a reduction in choice for older people and the application of inappropriate care packages, in the rush to avoid reimbursement.

"We feel that the introduction of this system of reimbursement will mean that patients are pushed onto a particular care pathway based on availability of provision alone."

Forum Response: Age Concern

A spokesman for Age Concern told ePolitix.com: "Age Concern believes that fining local authorities for not getting people out of hospital fast enough could result in premature discharges of older people.

"The proposals are process driven rather than people driven. We're really concerned about the emphasis on 'speed' because it could result in older people's rights and full involvement being overlooked.

"If older people are moved on too quickly the right care package might not have been arranged, for example not all older people want or need to go into a residential care home and may prefer to be cared for in their own home. It can also result in a higher percentage of re-admissions to hospitals if older people are removed before they have made a full recovery.

"Social services may now also be forced to concentrate their resources on getting people out of hospital instead of helping them at home."

Forum Response: Local Government Association

A spokesman for the LGA told ePolitix.com: "Since the government first floated the proposals to charge councils in April of this year, local government leaders from all parties have voiced their strong opposition. Charging councils for delays in discharging is not only divisive - undermining the good working relationships already established between health and local government - the concept itself is ill-conceived.

"Charging local councils focuses on only one element of a complex and interdependent system involving social services, health bodies such as hospitals and PCTs as well as private and public residential care. In focusing only on councils the government is not recognising that there are many reasons for delays in discharging older people from hospital - reasons include process delays in hospitals, patients themselves exercising choice, lack of funding in social services departments."Alongside a fundamental concern about the proposals which have been 'imported' from Sweden - where the financial and administrative arrangements are different - the LGA is worried about the costs involved and the timescales.

"To avoid fines councils will need to use their already overspent and stretched social services budgets to create additional capacity upfront. This will mean taking money away from older people's services in particular (such as preventing hospital admissions and care at home) and possibly cutting services for other vulnerable groups.

"The government hopes to implement the measures set out in the bill by April 2003 (only four months away) - in Sweden the charging approach was phased in over two years."The bill is short on detail - leaving that to regulation. We would like to see more detail on the face of the bill, and a radical change in approach from the government. Let local councils and health bodies build on the partnerships they have developed, and if new measures are to be implemented - let parliament scrutinise the detail.

"Without testing new approaches, allowing an achievable timescale for implementation and focusing on the whole system (rather than penalising councils) older people will be the losers if this bill reaches the statute book."