Bed blocking bill will mean worse care, extra costs

Alan Milburn's Community Care (Delayed Discharge) Bill will mean worse care for older people, an increase in emergency readmissions to hospital and extra costs to the taxpayer, Liberal Democrat Spokesman for Older People Paul Burstow MP predicted today.

Mr Burstow, who has already estimated that the Bill would cost local councils nearly £50 million if implemented tomorrow, revealed that emergency readmissions to hospital of over 75s has risen by nearly 11% to 122,357 since 1999.

Mr Burstow said:

"This Bill will mean worse quality care for older people. There will be more chance of older people being placed in inappropriate care. For many older people, this Bill will lead them straight back to hospital.

"Social services departments will, naturally, be keen to avoid fines. That can only mean that they will accept people into care from hospital whether they have appropriate placements or not. People at home awaiting a care assessment will also suffer, as they will be pushed to the back of the queue.

"Emergency readmissions to hospital have risen by nearly 11% since 1999. This Bill will only make the situation worse, as more older people will be readmitted to hospital after inappropriate care placements.

"Councils are already budgeting to cover fines. If this Bill were implemented tomorrow, every household in England would pay £2.30 more in council tax per year to cover fines. In the South East, every household would pay £4.37 more per year.

"On top of all that, it is far from clear whether this Bill is consistent with the Human Rights Act.

"This Bill, combined with the underfunding of social services, is a recipe for conflict between hospitals and social services."

ENDS

Notes to Editors.

Emergency Readmissions

Emergency readmissions of patients over 75 within 28 days of being discharged between April 1999 and April 2002

Region Jul-June 99/00 Jul-June 00/01 Jul-June 01/02 Percentage Increase from 1999 - 2002 Total increase

England 110,627 120,122 122,357 10.6% 11,730

Figures from Parliamentary Written Answers on emergency readmissions to Paul Burstow MP. Hansard links available on request from Richard Stokoe on 020 7219 1196

Total cost to council tax payers of "bed blocking" fines in each region

Region (NHS region) Total in yearly fines (£) Average Council Tax per dwelling 2001/02 per year (£) Number of dwellings on valuation lists (26 March 2001) Total council tax collected (£ billions) % of council tax Rise in average council tax per year (£)

North East & Yorks & Humber (Northern & Yorks) 3,244,800 669.50 3,300,000 2,209,350,000 0.15 1.00

North West (North West) 3,655,200 732 2,983,000 2,183,556,000 0.17 1.20

East Midlands (Trent) 2,114,400 713 1,798,000 1,281,974,000 0.16 1.14

West Midlands (West Midlands) 5,108,000 718 2,231,000 1,601,858,000 0.32 2.30

East of England (Eastern) 4,289,600 762 2,316,000 1,764,792,000 0.24 1.83

London (London) 9,447,360 764 3,108,000 2,374,512,000 0.39 2.98

South East (South East) 14,803,200 809 3,388,000 2,740,892,000 0.54 4.37

South West (South West) 6,247,200 745 2,174,000 1,619,630,000 0.39 2.91

England (England) 48,909,760 741 21,299,000 15,782,559,000 0.31 2.30

• Currently there are no organisations supporting the plan to fine social services departments. The Welsh Assembly and Scottish Executive have decided to tackle the problem of delayed discharge with investment of £17million rather than fines. In Scotland, the most recent initiative alongside investment into care home and home care services has been a special learning network and a national information bank. The learning network will provide a forum for senior staff working in health, housing and social services to learn about initiatives that have been effective in tackling delayed discharge in other areas. In a Health Select Committee hearing in July 2002, Jacqui Smith admitted to the chair of the select committee David Hinchcliffe MP that many people within the Department of Health were opposed to fining councils for delayed discharges. (HoC Health Committee, Delayed Discharges 3rd Report of Session 2001-02, Volume II, 19th July 2002, EV215 Para 667)

• Mr Milburn said that the fining system was based on the 'Swedish Model'. In the Swedish reforms of health and social care, responsibility for care and for expenditure were shifted away from more centralised government to local government. Parts of the taxation system were shifted the same way. In Sweden there is now a local income tax both on the local council level and on the regional council level rather than a centralised tax based system.

• As a further part of this package, regional income taxes were reduced and the local income taxes were increased. All this took place in 1992. Ten years on and the Swedish Government has taken stock and has changed the law so that the hospital doctor must obtain a commitment from the GP to a community medical care and treatment plan, before the penalty clock starts ticking. There have also never been any targets set by the Swedish Government in the reduction of delayed discharges from hospital.