'Bed-blocking': an evaluation of the role of financial incentives in the Community Care (Delayed Discharges etc>) Act 2003

This study contributes to the evaluation of the role of financial incentives in achieving the reduction of hospital delayed discharges attributed to the implementation of the
Community Care (Delayed Discharges etc. ) Act 2003. This policy imposes financial penalties for social services departments in England unable to provide the community
care services required to discharge patients within set timescales. Once a multidisciplinary team decides that patients are safe to be transferred out of the hospital, social services are given three days to organise the discharge. If patients do not leave on the third day, a fine is imposed to social services of £100/120 per day and
per person. This programme aims to resolve the issue of `bed-blocking', the loaded term used to describe patients whose discharge from hospital is not timed within the
speed desired by the institution.

This thesis performs a theory-driven evaluation, analysing the theoretical basis underpinning this complex policy following the realist framework. The use of a case
study approach based on multiple methods of data collection in `real-time' helps unravel the complexities of this multi-agency initiative. Fourteen patients were followed through their hospital stay to identify flows and blockages in the
programme. This data was compared with knowledge gained from other evaluations as a means to generalise the findings. The analytical process demonstrates that the
Delayed Discharges programme is an amalgam of multiple innovations which includes financial incentives. Some of theseo ther measuresin tertwined with the fines to create mechanisms that, planned or unplanned, reduce delays or avoid fines. Sometimes they do it at the same time, but on occasions they do it in isolation. Consequently, mechanisms are embedded in the designed programme theory that allow for fines to be avoided without delays being necessarily reduced.