Examination of Witnesses (Questions 636
- 639)
WEDNESDAY 19 JUNE 2002
JACQUI SMITH,
MP, MR RICHARD
HUMPHRIES, MS
MARGARET EDWARDS
AND MS
ANNE MCDONALD
Chairman
636. Colleagues, can I welcome you to this session
of the Committee. Minister, we are very pleased to see you again.
Would you like to introduce yourself and perhaps your team could
introduce themselves?
(Jacqui Smith) I am Jacqui Smith, Minister with responsibility
for community care in the Department.
(Ms McDonald) I am Anne McDonald, head of the Health
and Social Care Joint Unit in the Department.
(Ms Edwards) I am Margaret Edwards. When we last met
I was Director of Performance, I am now Director of Access and
Choice in the Department.
(Mr Humphries) I am Richard Humphries, Director of
the Change Agents Team in the Department of Health, set up to
tackle late discharges.
637. Thank you very much. This is the last session
of the inquiry into late discharges and can I again thank the
Department for its co-operation and the information you have given.
When the officials appeared at the start of the inquiry one of
the first questions I asked was on the issue of the costs of delayed
discharges to the Health Service and we quoted certain figures
which had come out of our public expenditure inquiry and the previous
inquiries we had been involved with and suggested certain figures
which may be the costs. I wonder, Minister, whether you have had
the chance to refine those figures in the time since we saw your
officials and whether you can come up with a broad idea of the
current costs? I appreciate the figures we looked at initially
have slighted changed and the official figure that the Government
is putting forward has reduced substantially. I believe at that
point it was 6,000, or one put forward was 6,000, and the last
figure was 4,500. Do you have any figures as to the overall costs
at this stage?
(Jacqui Smith) The important thing which I think was
raised when the officials came is that actually it is quite complicated
to come up with one overall figure which could represent the costs.
Perhaps it might be helpful if I took the Committee through the
sort of complexities and how we might build up some idea of what
the costs would be. We can narrow down the areas. Firstly, as
I think you received in terms of extra evidence after the last
session, the costs of generic hospital care we could cost at about
£242 per inpatient day including overheads, so that would
be about £1,700 per week, but I do not think it would be
satisfactory in terms of costing a delayed discharge to take that
as our figure, for two reasons. Firstly, because that tends to
suggest that the costs of care are evenly distributed throughout
the time somebody is in hospital and obviously it is more likely
that costs will be front-end loaded, that it is more expensive
in your first few days. Secondly, there are going to be some specialties
which are more likely to be affected by delayed discharges than
others. So if we then refine slightly further and we think about,
for example, the specialty costs for old age medicine as a costing
for the care of people affected by delayed discharges, we get
to a figure that is £144 per day. That is according to the
Personal Social Services Research Unit, Unit Costs of Health
and Social Care 2001. It is less because it reflects the less
intensive medical, surgical and nursing supervision but in fact
even in that case it is likely to be the case that there is front-end
loading as well in terms of care. So putting those factors together
we can see the costs of delayed discharges are actually likely
to come somewhere probably below £1,000 per bed per week.
I think it is important to point out clearly we want to be able
to have some view about what the costs are to the Service of delayed
discharges but actually we also all recognise the whole range
of complexities involved in delayed discharges, not only in terms
of the actual costs of the acute bed that is being used but also
the impact on the whole system of the opportunity costs of what
could be happening and, perhaps most significantly of all of course,
the impact that it has for the patient themselves; the older person
who is in an acute hospital bed when that clearly is not the right
place for them to be and the people who potentially are not able
to get treatment because that bed is not being used appropriately
at that particular time. On that basis, whilst it might not be
a simple case of saying, "This is how much it costs",
there is probably agreement that this is an issue which is important
for individuals and the whole working of the system of the health
and social care community, which is why we need to find appropriate
ways to continue the progress that the Government has made in
reducing those levels of late discharges.
638. You recognise clearly that one of the reasons
we as a Committee focused on this area and the reasons the Government
has focused on this area is because if you have people who occupy
beds who do not need to be in them you are preventing others who
may need to be from being admitted and there are knock-on consequences
on waiting lists. One of the reasons why I am particularly interested
in the cost of this problem is we are looking at solutions which
are also costly and we need to balance the cost of those solutions
against the cost of the problem. I would be interested in whether
it is possible to extrapolate from the various estimates you have
given, and I understand you have qualified them and why you have
qualified them, to look at the overall cost. It may be the Committee,
in picking up the figures you have given us, can do some work
on that in our report. One of the things I want to ask you about
is that you have looked specifically at the varying costs of somebody
occupying a bed, has the Government, either individually in your
Department or with your colleagues from the other department in
the same building as yourself, actually looked at, for example,
the costs on the benefits system of the inability to admit people
as a direct result of there being no beds, the costs to employers
and within your Department the budget implications for example
of needing to offer for example district nursing services to people
who need particular care in advance of the acute phase, or the
GP costs or other wider social care costs? Has that been examined
at all in the work you have done in looking at the big picture
on this issue?
(Jacqui Smith) I would have to get back to you on
whether or not there has been any detailed work on that. I am
not aware of it, actually partly because, as you have identified
through that question, there are so many complexities involved
in the whole system in relation to costs which fall not only on
health and social care but also, as you have pointed out, in terms
of, for individuals, what any period of disability let us say
or any period of waiting to go into hospital would imply for their
employment prospects or whatever. If we have more information
perhaps I could ensure that the Committee gets that, but I think
the conclusion that it sounds like we are both drawing is that
this is an extremely complex, whole systems issue. I would not
want the Committee to think that because it is not possible for
us to quantify because of its complexity that we do not therefore
think it is significant. We do, not least for the service and
individual consequences of it, and that is a very important reason
for taking action and continuing to take successful action.
John Austin
639. Have you looked at all into the impact
of delayed admission and its impact on this that if someone's
admission is delayed, by the time they are admitted their length
of stay is likely to be longer than if they were admitted earlier,
or that there is a knock-on effect, particularly in areas like
orthopaedics?
(Jacqui Smith) Once again, if we have detailed information—although
I am not sure, I do not think we have on that—then I shall
make it available to the Committee. If your contention is that
it is bad for the system as a whole if people are not able to
get into hospital because we are not making the most effective
use of our acute hospital resources, I agree with that contention.
That is why this is about a whole-system approach.
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