The BGS Council in England became anxious during the middle of 2005, that many trusts were closing rehabilitation beds in response to financial pressures. To assess the extent of the problem a survey was performed.

The database of contact information for the lead geriatricians in each trust was updated with the help of the English regional council reps. The 164 lead geriatricians from each acute trust in England were approached and 74 replies were received before the deadline (45% response rate). This report is based on their responses.

There has been an alteration in the bed base in 70% of the respondents' hospitals for the period April 2003 up to that expected by April 2006. Table 1 lists the total number of beds in each category in the trusts that responded.

There has been a small reduction in the number of acute elderly care beds but the overall figures disguise some major increases or reductions in individual trusts. The free text comments reflect an air of despondency in many services in England, trying to offer services to older people against a background of deep NHS financial crisis.

There has been a major reduction in NHS rehabilitation bed numbers with more than half of respondents (52%) citing finance as the reason for closure. There were only 5 trusts who were going to re-provide NHS rehabilitation beds elsewhere in either the acute hospital or in a new build.

1399 (18.2%) of the 7688 rehabilitation bed have closed in the survey period with slightly more of the community rehabilitation beds closing despite that being considered to be an excellent setting for intermediate care. 58% of the closures were permanent.

The increase in residential intermediate care beds in the districts surveyed does not get anywhere near to the numbers of NHS rehabilitation beds closed, even when combined with the creation of transitional care beds for care home waiters and delayed discharge patients.

The majority of residential rehabilitation beds have been established in residential care home settings (6 /10) with nursing home settings less common (3/10) and one non acute hospital site has provided a setting for intermediate care.

Very few medical sessions have been provided to cover the intermediate care beds. Only 15 GP sessions, 4 junior doctor sessions and 5 consultant PAs were reported to cover the 10 new intermediate care sites in the survey.

Transitional care for care home waiters was only established in 2 districts in a nursing home setting.
There has been an increase in consultant geriatricians’ presence on acute medical units. It is recognised in the BGS in England that a number of Acute physician posts are being filled by geriatricians. In contrast however, there was only a small increase in the number of consultant geriatrician sessions being deployed in Intermediate care. The cover there is usually being provided by GPs.

Many rehabilitation beds that have closed may not have provided particularly intensive rehabilitation, particularly if therapy resources were limited. The widespread closure of rehabilitation beds could potentially have released the therapy time from those wards to augment the therapy provided to patients in the remaining care of the elderly beds. There was, however no evidence that this was happening as the 21% of sites who achieved increased therapy provision to the remaining beds was matched by 18% who, despite the rehabilitation bed closures, suffered a reduction in the therapy provision to the other rehabilitation patients.

The results of the survey were used in a Dept of Health discussion with Ian Philp to highlight to both Ian and ministers, our concern regarding the diminishing provision of rehabilitation facilities to older people. There is real fear that this trend will continue unchecked under the Payment by Results policy unless the tariffs set for the rehabilitation treatments of older people reflect the need for comprehensive assessment and treatment.

James Barrett
Chair
BGS England Council