THE Parliamentary Health Select Committee visited Canada and the USA to study delayed discharges from acute hospital care.
Staff in Vancouver have avoided the unfortunate term "bed blockers" and instead use the abbreviation "ALC" for patients who no longer need acute care but require an alternate level of care.
They are moving towards the integration of acute hospital and community care services, the system we had in Kidderminster before the dissolution of our combined healthcare trust.
They have also realised that discharge planning begins at home before an elective patient has been admitted to hospital or, in the case of emergencies, at the beginning of the admission.

Discharge is planned by the multi-disciplinary team looking after the patient in the acute hospital ward with representatives of the relevant outside agencies.
Again this system was in use in Kidderminster years ago and will be in any well-managed NHS hospital.
In some hospitals it is further refined by the addition of a care services manager, who is responsible for organising a patient's journey through the hospital system - an excellent innovation which immediately frees doctors and nurses for clinical duties.

Doctors are penalised financially if admissions are inefficiently prolonged.
In addition there has been more investment in intermediate care facilities - for example, nursing homes and rehabilitation facilities - and so the problem of delayed discharges is less in Vancouver than here and virtually unknown in Boston, Massachusetts.

I noted two particularly stark differences in hospital care between here and North America.

The first is that telemedicine is being introduced in British Columbia to improve services to local isolated communities before there is any thought of downgrading local hospital services.
Here telemedicine was promoted as an alternative to justify the closure of local acute hospital services.
Computer systems downtime is, therefore, far less significant in British Columbia than here, as the original services are still intact.

The second difference relates to clinical staffing.

Nurse practitioners are more numerous and have wider responsibilities. Junior doctors in training only work in teaching hospitals.
A small district general hospital for 150,000 citizens in Boston has a rota of 10 cardiologists on call for specialist advice and help. Are there 10 cardiologists in Birmingham?

My overall impression is that hospital care is easier, with greater financial resources, and that the wishes of citizens, potential patients and customers, are paramount because hospitals depend on these same citizens for their income.
Waiting lists and delayed discharges are less of a problem.

The health committee now has to incorporate the findings of the visit into the report on its study into delayed discharges here.