When the Mental Welfare Commission (MWC) visited the Edinburgh Royal Hospital in February it found conditions out of another era.
Patients were seemingly being routinely dressed in clothes that were not their own, a patient's false teeth had not been cleaned and the use of powerful sedatives to deal with boredom or distress appeared to be standard practice.
Lack of staff was leading to poor care, including patients left in bed until lunchtime because no-one had time to get them up.
The watchdog's findings are notable for their candour. Unusually outspoken, it repeatedly talks about "serious concerns" and warns patients' conditions are being made worse.
The degree of apparent alarm from the MWC makes it puzzling that the issue only came to light as a result of the inquiries of concerned family members of Peter O'Malley, who died in October. Mr O'Malley's care prior to his death should concern us all and has both local and national resonances.
His relatives have called for Healthcare Improvement Scotland to inspect urgently, and this is worth considering. Although HIS only has responsibility for acute hospitals at present, it has built up an expertise in assessing the care of older people, and a reputation for getting things done.
As things stand, NHS Lothian has promised to act on the MWC's findings and must do so without delay.
But the MWC blames the problem at the Royal Edinburgh partly on a crisis in care home provision in Edinburgh, and this raises wider questions. On one ward, 75% of the patients should not have been there, according to the MWC, but had nowhere to go as they were waiting for suitable social care to be arranged.
Edinburgh's crisis is caused in part by the number of local care homes deemed unsuitable for new admissions after critical reports by the Care Inspectorate. But it is not just the capital which has seen a rise in bed-blocking. Figures earlier this year showed the number of patients facing "delayed discharge" because of a lack of places in the community had risen by 165% Scotland-wide.
This is a worrying symptom, a barometer of the wider problems highlighted in The Herald's Time For Action campaign. This paper has been calling for a review of capacity in hospitals and in social services to look at how Scotland can be equipped to cope with an ageing population.
Although we know the rising elderly population will put pressure on health and social services, progress can be hard to measure. Bed-blocking offers one of the clearest alarm signals we have about whether services are coping. If social care services were adequate, the problem would be diminishing, but it is getting worse.
We face some tough decisions about our expectations of social care, and how we finance that. How do we pay for the increased provision we need? Are problems with staffing partly due to low pay and related high turnover? If so, how do we pay care staff better?
Bed blocking is a symptom of a wider malaise. These discussions need to start soon, and at a Scotland-wide level.
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