Bed-blocking in the National Health Service in Scotland: a study of bed-blocking in Scottish National Health Service trusts; its nature and extent.

OBJECTIVE: To determine the perceptions of managers in Scottish NHS trusts concerning bed-blocking. To help determine the causes of bed-blocking and suggest possible solutions to the problem.

DESIGN: The first part of the study consisted of qualitative research interviews with key figures in NHS trusts and an examination of the existing literature on bed-blocking. This informed the second stage which was based on a questionnaire survey of senior managers in 35 trusts.

SETTING: Interviews were carried out in three trusts in Forth Valley Health Board and Grampian Health Board areas. Questionnaires were sent out to 44 trusts throughout Scotland. The three trusts that were excluded from this study did not contain bed-blocking patients.

SUBJECTS: Questionnaires were sent to chief executives of 44 NHS trusts in Scotland. Respondents were nominated by chief executives on the basis of their experience and understanding of bed-blocking problems within their own trust.

RESULTS: Of the 44 questionnaires sent to trusts in Scotland, there were 35 responses (80%) which identified a total of 1845 beds as being blocked. The NHS secondary care-based respondents indicated that social services were responsible for 1406 bed-blocking patients in 35 trusts, an average of 40 patients per trust between August and September 1997. Some 600 of these "social services responsible" bed-blocking patients, an average of 21 patients per trust, were reported as awaiting comprehensive assessment by a social worker. In addition, 710 of these "social services responsible" bed-blocking patients, an average of 24 patients per trust, were awaiting funding authorization for a nursing home or residential home placement. NHS trusts were responsible for 237 bed-blocking patients, an average of seven patients per trust. In a further 202 cases bed-blocking was deemed to be neither the responsibility of the trust nor of social services as patients were awaiting vacancies in the patient's or carer's specific choice of residential or nursing home.

CONCLUSION: Results from this study show that there would appear to be a significant number of blocked beds in NHS trust hospitals throughout Scotland. Trust staff, whilst acknowledging the complex nature of bed-blocking, perceive social services, who are responsible for the assessment, placement and financing of patients being transferred from hospitals to residential care in the community, as being responsible for the majority of these beds being blocked. It is, however, acknowledged that social services are under-funded and under-resourced. If the situation is to be improved, consideration should be given to changing service delivery processes in the context of the implementation of Designed to Care.