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Do hospitals simply need more beds?

The sight of patients lying on hospital trolleys and handwritten signs warning others of an eight-hour wait for beds feels like something out of another era.

Ending bed-blocking was to be the answer. It was not quite a case of "been there, fixed that", but many people imagined we were at least well on the way to finding the solution.

So the revelation by Health Secretary Alex Neil that 25% of patients who no longer needed care in four health board areas were unable to be discharged from hospital is an alarming surprise.

The figures are from a recent audit of patient discharges which covered NHS Lothian, NHS Borders, NHS Fife and NHS Lanarkshire. Between them they offer a reasonable balance of rural and urban populations and enough of a geographical spread to suggest this may well be representative of the national experience.

Age Concern says the new figures provide confirmation of the need for ministers to compel hospitals and community services to work together better. The merging of health and social care is an ongoing project, and one of the Scottish Government's legislative priorities. Meanwhile, an action plan for emergency care might provide an early opportunity to address the problems.

The Scottish Government has announced it is to invest £1million to fund additional Accident and Emergency consultants and their remit will include speeding up patient discharges, which may help. Given that this will only fund around one consultant in each mainland health board, it may not help much, the impact might well be limited. In any case, it is misleading to see this as primarily an A&E crisis.

Casualty departments cannot move patients on because beds on other wards are in short supply, and those beds cannot be freed up because patients are waiting to return home. This visible problem may be patients "piling up" in A&E units, putting pressure on staff and facilities, but the core problem is not new.

If there is still a shortage of care and support services in the community to enable elderly patients to return home, we have to ask why.

There is an argument that the longer patients are in hospital unnecessarily, the greater the chance becomes that they will suffer further illness, and the less independent they are likely to be able to be when they return home.

It is clear we do need faster improvements in the Cinderella social services to ensure patients get the care at home they need, or the mobility support and help regaining skills they need to live independently.

But there is another question. Social work leaders say the necessary services are there, but patients are asking for more time to consider the options and consult their families about life-changing decisions before leaving hospital.

It could be that we have gone far enough with rushing patients back to their homes and need to acknowledge that in some circumstances what health boards need are simply more beds.

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Health

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