Research Student: Ana Manzano-Santaella
"Bed-blocking": an evaluation of the role of financial incentives in the Delayed Discharges Act 2003
Delayed hospital discharges have been identified as a problem for the NHS and have prompted several policy and service development responses in the last decade. One of these was the controversial introduction of fines for social services departments unable to discharge patients from hospital within the agreed timescales (The Community Care (Delayed Discharges, etc) Act 2003). The aim of this policy is to reduce the number of patients “bed-blocking”, that is, medically ready to leave hospital but unable to do so because of their social needs.
After implementation, increased rate of hospital re-admissions and residential care admissions were observed. In contrast to initial evaluations based on simple outcome measures concentrating on time of discharge to measure efficiency, this research performs a formative process evaluation using the realist framework. Case studies are followed through their hospital stay so as to identify flows and blockages in the programme. Following up each case with a mix-method approach reveals the particular circumstances in which it operates and it facilitates sensible testing of theory.