It’s one of the single biggest issues facing the health service in Fife - bedblocking.
Solve it, said one senior executive, and you automatically fix other problems too.
‘‘If beds are freed up, it means patients get home faster, and people arriving in A & E are moved quicker ... and you also end the negative press coverage,’’ he said.
Bedblocking isn’t a new issue - it’s been the bane of many health service executives for years - and neither is the ‘who’s to blame’ debate that goes on between the NHS and the politicians.
And while they argue over funding - or a lack of it - it’s patients who suffer.
Bedblocking, stripped of the gobbledygook or admin-speak of ‘delayed discharge’, happens when people can’t leave hospital after their treatment because there is no support in place for them to recuperate at home.
And the longer they occupy that bed, the longer folk coming in via A & E and general admissions have to wait.
That in turn sees everything else back-up - all it takes is one outbreak of illness in the community, and everything lurches towards crisis mode.
An exchange of letters between NHS Fife and the Scottish Government this week underlined the frustrations of all concerned.
The correspondence was dated from the autumn, but the issue, if anything, is more acute as we head into winter.
Allan Burns, chairman of NHSFife, wrote to Alex Neil, then Cabinet Secretary for Health, expressing his board’s ‘‘grave concerns’’ on the pressures facing his staff.
When it comes to getting patients home after treatment, Fife has one of the poorest records.
‘‘We have worked closely with Fife Council in an attempt to find a sustainable solution to this perennial problem, but, after a year, this appears beyond our reach.’’
At the heart of the issue lies a funding gap between what the NHS needs to send people home, and what Fife Council can afford in the way of care packages.
‘‘It is clear the budget allocated to home care does not match the community need, and the Council has no immediate intention to fund the gap,’’ added Mr Burns.
In simple terms, that means anywhere between 70 and over 120 people are stuck in beds in hospital when they should be at home recuperating.
And the bill for that is put at some £3.6million per year.
The backlog is now at its highest since 2011 - and it is impacting heavily on the health service.
‘‘Whilst we operate a safe hospital, we are experiencing much higher levels of risk to both patients and staff,’’ wrote Mr Burns. ‘‘This impacts negatively on both, with patients finding themselves waiting extended periods and being boarded un-necessarily, and staff experiencing unreasonable stress and often absence.’’
And he summed up the problem thus: ‘‘NHS work towards care of patients, the Council works to budget targets - and once reached, care packages are withheld with the NHS continuing to provide clinically inappropriate and un-necessarily expensive in-patient care.’’
Mr Neil said NHSFife had received £500,000 as part of a £5m pot to help boards ease the pressures, but saw it as ‘‘a partnership problem;’’ that needs ‘‘a partnership solution.’’
‘‘Having someone un-necessarily occupy a hospital bed after treatment is completely the worst outcome for the individual, at highest cost,’’ he added.
Alex Rowley MSP, who has called for an independent inquiry into the running of the health board in Fife, has also asked Fife Council for a wealth of data on home care packages.
In correspondence to Councillor David Ross, leader of the local authority, he said: ‘‘It is really important that we do have a review of the health and social care needs so we have a real understanding of the level of resources required.’’
He said there was ‘‘no clear policy or direction’’ for funding the growing demand for community care, and he hoped the Council and NHSFife would come together to make the case ‘‘for the proper levels of funding.’’