Swindon social services is confident it can beat large fines introduced under the Government's tough action to tackle the problem of bed-blocking in hospitals. MICHAEL LITCHFIELD reports.

IT has been a plague few hospitals have been able to cure. Bed-blocking has bedevilled Swindon's hospitals old and new no less than in other crisis-hit parts of the country.

During 2002, for example, 400 patients a month were being kept on trolleys in corridors at the Princess Margaret Hospital because there were no beds available.

One patient had to wait 43 hours on a trolley before a bed in a ward became available. Similar horror stories were sadly too common.

And even before the Great Western Hospital at Commonhead was opened, its chief executive, Sonia Mills, was warning that there would not be enough beds to cope with the expected volume of patients.

Bed-blocking or "delayed discharge" in hospital parlance arises when a patient is fit to go home but cannot do so for social or domestic reasons, rather than medical conditions.

Usually the patient is elderly, frail and in the care of social services. Often the blocking happens because care homes find themselves unable to take residents back in after hospital stays.

But the pressure on beds in hospitals is mirrored in care homes, especially as so many of them are closing because of new government legislation that has tightened the regulations over the size of rooms, facilities and occupancy levels.

The Government, clearly believing that councils were not doing enough to ease the problem, has introduced £100-a-day fines for every patient in social services care who is still in hospital 48 hours after the discharge deadline.

The power for hospitals to levy fines against councils kicked in from the beginning of this month. However, the big stick solution has been softened by a soothing cash-carrot. Swindon Social Services, for example, has been given an extra £140,000 for this year to help pay-off penalties and to finance new initiatives.

The parliamentary push, combined with the sweetener, has already produced a remarkable improvement in Swindon.

Until recently, there was an average of 18 patients a day at the Great Western Hospital for whom Swindon Social Services could have been fined under the new legislation. That number has been cut to an average of three. This means that social services will be able to pay any fines out of the Government handout, without having to pass on the burden to the taxpayer.

However, as always, there is a sting in the tail.

"We've been given this cash because it's a Government initiative, but there's no guarantee that there'll be any extra money forthcoming next year," said Coun Jemima Milton (Con, Wroughton and Chiseldon), the lead member for social services.

"We should be all right for this year, but it's 2005 that I'm worried about. We could find ourselves left high and dry."

In addition to the doubt over future Government funding, Swindon Council is poised to axe two of its care homes, putting further pressure on social services because of the reduced accommodation for the frail and elderly.

"We've got the numbers down by introducing community-based schemes and working closely with the health authority," explained Coun Milton.

"But I'm a realist and know that there will always be cases that cannot be solved within such a tight timetable.

"I cannot see us bettering the average of three. Of course we shall always be aiming for zero, but I don't think it will ever be attainable."

In July 2002, the Government set Swindon Council the target of reducing the number of bed-blocking cases at any one time to 11. Along with the directive came a cash infusion of £554,000. Council officers recommended that £280,000 of that money should go towards meeting the cost of a five per cent drop in care home fees.

At that time, Coun Milton said: "This money is welcome and it has to be very carefully targeted, but there's never going to be enough in social services."

The hospital management and the council seem in agreement that cash is a palliative but not a panacea.

Michael Litchfield