Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 636 - 639)




  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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