Report reveals financial incentives behind hospital bed blocking

• Health care system conditioned to put older people at risk
• NHS staff “battle a system that is working against good care”
• Protectionism and cultural differences are preventing greater integration
• 78% of over 55s say bed blocking is the key issue politicians should be focussing on at the moment
• Urgent recommendations made to unblock health and social care

‘Bed blocking’ in hospitals and A&E wards is being financially incentivised, according to a new report by independent think tank Localis, in partnership with older people’s charity Anchor. 

The report ‘Unblocking: Securing a health and social care system that protects older people’ to published today, explores the failures of the health and social care system, which is resulting in sub-standard care for the older population.  

With the cost of keeping a patient in a hospital bed standing at around £1,600 per week, the NHS is footing excessive costs caring for patients who are not in need of medical attention, as well as preventing other patients from receiving the appropriate care they need. 

The study, involving more than 100 health leaders and senior local government figures[i], revealed 61% felt perverse financial incentives are a major barrier to integration of health and social care. Looking specifically at ‘bed blocking’, 46% stated the lack of incentives, especially financial, were one of the main underlying causes. 

In a recent survey of 2,000 Brits aged 55 and over, commissioned by Anchor, ‘bed blocking’ was identified as the number one issue that should be addressed by politicians.[ii]

The report finds that protection of budgets was the number one answer when participants were asked what was holding back integration of health and care services.

Interviewees were also firmly of the view that the current ‘Payment by Results’ system offers a built-in incentive for hospital trusts to keep patients in hospital for longer than necessary, with a system conditioned to reward the level of treatment rather than results for patients.[iii]

The research also exposed the belief that UK healthcare does not do enough to prevent avoidable injuries for older people: one in ten of those aged 75 and over was admitted to hospital with potentially avoidable conditions, yet only 4% of the NHS budget is spent on prevention.[iv] In the words of one interviewee: “We have a system designed to cope with demand when it happens, not prevent ill-health in the first place.” 

With the number of people aged 65 and over set to increase by 50% in the next 15 years, the charity is warning that urgent reform is crucial to prevent a collapse in frontline services. 

The report makes five key recommendations to prevent excessive hospital admissions, delayed transfers of care and unnecessary health costs in the future. 

Recommendations include:  

1. Better coordinate care for the elderly by introducing single budgets for health and social care
2. Provide budget stability and allow for long-term strategic planning – the next Government needs to commit to a fixed five-year budget to tackle health and care issues 
3. Shift the blame away from blameless patients – stop using the term ‘bed blocking’, which points the blame at the patients rather than the real culprits: the systemic problems in health and social care. Instead refer to ‘preventable bed occupation’

Anchor is among those tackling the lack of integration between health and social care, piloting a scheme in partnership with Birmingham City Council and Birmingham CrossCity Clinical Commissioning Group (CCG). Four of Anchor’s care homes in Birmingham have been participating in the scheme since mid-December 2014, where 12 rooms are on offer for rehabilitation to elderly patients who are not yet able to go home, but do not need further medical attention. The scheme is now being rolled out more widely and has already seen significant cost reductions with estimated savings of up to £300,000 per year.

Jane Ashcroft CBE, Chief Executive of Anchor, says the systemic failures that are incentivising poor care for the country’s older people must be addressed:

“It is older people who are suffering the most from a lack of health and social care integration - facing unnecessary admissions to hospital, experiencing lengthy discharge delays and poor standards of care. No matter how dedicated NHS staff are, they are constantly battling a system that is working against them. Now is the time to take action to protect the safety of our older generations now and in the future.” 

“We’ve heard the same rhetoric from political parties that integrating health and social care is vital but too little progress has been made. As the report recommends, a Minister for Older People could encourage more integration to benefit the older people of today and tomorrow.” 

“The few inspiring examples dotted around the country demonstrate it is achievable, and essential to avoid the kind of NHS crisis seen earlier this year.” 

Localis' chief executive, Alex Thomson, directed the research carried out, he says: “Our research highlights how entrenched the problems caused by lack of integration in our health and social care system are, and the knock on effects on older people especially. But we do identify some glimmers of hope. In particular, we think that local government has an unparalleled capacity to help drive the necessary coordination between health and social care in order to deliver better care for older people, and others.” 

Read the full report here.

[i] This report incorporates the results from extensive interviews with health and social care experts from around the country, and a survey of more than 100 local health leaders - Health and Wellbeing Board Chairs, Council Leaders and Chief Executives, Directors of Public Health and other senior local government figures.

[ii] YouGov survey of 2,000 of Brits aged 55 and over commissioned by Anchor. Bed blocking was identified by 78% of respondents as the key issue politicians should be focussing on at the moment. Total sample size was 2,012 adults aged 55 and over. Fieldwork was undertaken between 20th and 22nd January 2015. The survey was carried out online. The figures have been weighted and are representative of all GB adults aged 55+.

[iii] In 2006-7 the Government introduced a system called Payment by Results (PbR). PbR governs transactions between commissioners and secondary healthcare providers representing more than 60 per cent of income for the average acute hospital. The intention for PbR was for it to align payment for work done by delivering on the promise that ‘money will follow the patient’. However, several interviewees felt that the scheme was not working as planned, with one calling it an ‘unmitigated disaster’. These interviewees all agreed that, contrary to its name, PbR was not paying for results (i.e. making people to get better) but was instead paying for activity. 

[iv] Only 4% of the NHS budget is spent on prevention: Butterfield R., Henderson, J. and Scott R. (2009) Public Health and Prevention Expenditure in England – Health England Report No.4. Health England. One in ten of those aged 75 and over was admitted to hospital with potentially avoidable conditions: CQC, The State of Health Care and Adult Social Care in England, 2012/2013.