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HEALTH service managers are not normally known for their use of emotive language, so this week’s comments from Lothian University Hospitals chief executive David Bolton about the impact that bed-blocking was having on the welfare of patients were surely a measure of his frustration with the intractability of the problem.

When dozens of operations have had to be cancelled and hundreds of patients across the Lothians are still waiting to be discharged from hospital to a care or nursing home, it is clear that Edinburgh Royal Infirmary is now facing enormous pressures.

As the major acute hospital in the city, which is also a regional centre for many specialist medical and surgical services, the ERI will bear the brunt of the failure of local authorities to find care homes for elderly patients, as well as any sudden, unpredicted increases in emergency admissions.

Yet given all the warnings which were voiced by some senior doctors before the hospital was built, are we now seeing proof that the ERI has too few beds to cope?

Before the ERI moved to Little France, the official line from the health board was that the reduced bed numbers at the new hospital would be more than adequate - but with two key provisos; firstly that the problem of delayed discharge was resolved, and secondly that there was sufficient back-up in the community from GPs and other health care professionals in primary care.

Bed-blocking remains a major challenge for the NHS, and action is urgently required to address the blockages in the system which delay treatment for patients and leave elderly people being cared for in an inappropriate setting. This should be a top priority for the Executive.

Some of the promised investments in community health care have also been slower than expected to materialise - take the example of Midlothian Community Hospital, which is expected to open in 2008, ten years after it was first proposed - which of course puts pressure on the acute hospitals including the ERI to cope.

In this context, the investment of an additional 33 million in health centres across the Lothians can only be welcomed. The bigger role that primary care can play, the better it is for patients, as services are delivered closer to home and hospitals can focus on emergency and highly specialised care.

The challenge now facing the NHS, in partnership with social services, is how managers can use the increased budget, which will top 1 billion in the coming financial year, to deliver a model of care which reduces waiting times for patients.