What’s the answer to ‘bed blocking’?

[Cuppasoupmonster]

Another day, another article about ‘bed blockers’ (put in speech marks because I know it’s a bit of a goady term).

I was shocked to find out a third of beds are taken up by ‘social patients’ in some trusts, who are medically fine to be discharged but can’t be because the care they need afterwards isn’t in place. I feel irate that the whole point of lockdowns to ‘stop the NHS from being overwhelmed’ needn’t have happened if it wasn’t overwhelmed in this way to start with.

Whats the answer? Early intervention so they don’t end up in hospital in the first place? A rise in taxes to pay for more services? I’m not sure the working population can afford to pay more tax.

The ‘ageing population’ issue means this can surely only get worse?

I had the opposite problem when DM was admitted to hospital. The doctor asked to speak to me as they needed to make arrangements to send her home despite her being barely conscious in bed and having heart and kidney failure. I'd been warned by her GP that this would probably happen and to tell them I wouldn't be caring for DM. The hospital doctor looked at me as though I was something she'd trodden on and told me in that case she'd have to involve social services. DM died four days later (thankfully in a different ward), on the day they were planning on discharging her.

It seems like only a matter of time before the next fall/hospital admission unless she’s supervised 24/7?

@Topgub
You didn't link anything relevant about hospital discharges lengths- and there is monitoring. You linked genetic websites talk about increases in delays generally for assessments due to covid pressures over past couple years. No shit Sherlock that is known info!

Covid has caused impact in all services. You've linked genetic weblinks that talK about community and other waits for assessments not specific hospital delayed discharge stats.

That's not news -,yes covid has caused waits in community as unprecedented influx work to do - and it isn't hospital length of regular delay stats.

It is terribly sad that your LA is underperforming- if it is - and we trust your word though no stats shared...

Ours and many others aren't.

It should be never be that people are regularly waiting in hospital for 3 months + for care packages throughout the year.

Doesn't sound like she needs 24 hour care so no need for a home yet. It's cheaper to keep her home too and if she is managing with support from 4x POC and family, why should she go in a home?

My Aunt was stuck in hospital waiting for a care package. There is such a shortage of carers they were struggling to arrange it. She needed a hospital bed and commode delivered as well which took ages.
Social care needs to be properly funded so people want to work in it.

Bit on the whole most LAs in England at least, likely other UK have worked hard to speed up hospital discharges . Huge expensive investments in that.

But If @Topgub 's LA and hospitals haven't , and regular people (even 80%) with regular care packages are sat waiting for 3 months for those, even a discharge then that is so so awful and should be front page news

As they will be one of few areas in England that failed to use extra millions of covid funding nor to invest and spend in discharge funding from hospitals. I wonder where they put that money ?

Even with 24 hour care, if a person a poor mobility, falls are inevitable. Keeping this lady independent in her home (providing she is coping and able to get around her home) is the ultimate goal.

Abhorr phrase bed blocker, I know it’s in parlance and daily usage..but that’s a real actual person. Not just a patient blocking a bed
what to do
employ OT , PT to assess and identify suitable step down provision
fund hospital at home reduce bed pressure
increase support worker /HCA wages as retail and catering jobs pay more
rapid treatment teams to dc home promptly with follow up

Yet people providing care for relatives saves the government £130 billion a year, so clearly many people do look after family members, often at great personal cost to their health and to their finances.

People are living longer, with more complicated needs. It's not always safe or practical for care to be provided by family.

And let's not forget it's usually women who provide the care. Often in this country, in the past when families were larger, a daughter (I had one aunt who remained unmarried and stayed home to look after my grandparents, my grandad really as my gran died quite young), in some of those cultures you talk about, it's the daughter in law.

Loads of people who go home with carers do not need to be euthanised. None of my relatives in this position wanted this. When my father in law went home with carers he had lots of family regularly visit and even went to his granddaughters wedding.
People working in hospitals do not see people at home and how much they can enjoy life once they recover from being ill in hospital.

Locally, in services, it's Delayed Transfer of Care (DToC), which is a better and more descriptive phrase.

I agree, there needs to be an interim place of care that frees up hospital beds before care at home can be sorted, the problem is that convalescent homes only delay the realisation that there aren’t enough people prepared to work for the poor wages that home care companies offer.

Maybe hospitals could have their discharge teams working evenings/weekends. My husband’s consultant said he was fit to go home one Friday afternoon but as the discharge team wasn’t available to process his discharge he remained in hospital over the weekend. Coincidentally, that same weekend a friend’s daughter was in A&E waiting to be admitted but no bed was available.

(In Topgub's area)
I really do hope that it isn't real and she has shared no stats other than generic news about how tough it is in the community causing delays in assessments. But that is not hospital discharge stats. (In her specific area. )
Lotsa Gov money spent to discharge people and peeve hospital discharge delays over past years. Will always be some but not regular

In cultures where people look after their elderly relatives at home, you do not have two adults working until 68 years old. You have one adult who either does no paid work or only works part-time. When the push was for everyone to work full-time and to have a later retirement age, the government were warned that fewer people would be able to care for their elderly relatives.
My mum cared for my gran, but she retired at 58 years old and cared for her mum once she herself turned 60. I will still be working full-time at that age.

Oh and by the way, labour's Care plan was a great idea. It just wasn't funded remotely enough - if they had got elected, it wouldn't be happening now even before the costs of the pandemic. Putting a few pence on income tax and "taxing the rich" isn't enough

Yes DToC. that’s used in LA and discharge teams.
The scary dc team coordinator who know the cost of an acute bed in London and will recite it at any opportunity

It's not euthanasia tho is it....it's the natural progression of dying. I'm a huge advocate for anticipatory care planing. Not only does it help the family accept what is happening to their loved one but it also allows healthcare professionals to have frank and honest discussions about dying and that not everyone should have all interventions thrown at them just because its available.....lots of time the kindest and most ethical things to do is nothing. People have such are hard time accepting that doing nothing or withdrawing treatment is in fact the best thing to do.

I'm not advocating for euthanasia at all. I'm advocating for not over medicating old age in the pursuit of prioritising life over comfort and dignity.

The human body isn't designed to live as long as we now expect it to. For many people the result is a long, cruel and undignified death.

I feel the same about any condition where there is very little quality of life remaining and also absolutely in favour of promoting life regardless of disability for as long as that person has some enjoyment and quality of life in being alive.

it's about encouraging people to think and write down their decisions about their own personal line in the sand, normalising advance directives and empowering families and professionals to promote wellbeing over existing.

Again Tory policy development team here perhaps? Or journo looking for outrageous comments?

DC teams work 24/7 weekend,eve, bank holidays to relieve bed pressure and help with DToC. Surprised being medically stable he wasn’t promptly dc and followed up in community. Unless a poc was required and no agency available to undertake it?
as an aside hope your husband is well now

They do

Social workers work over weekends on complex assessments (simple ones go through shorter process) but unfortunately most care agencies don't take on new packages and clients to start in way or Sunday, unless a specialist rapid response discharge short term reablememt team. Nor carehimes will admit someone over weekend as the registered managers don't (understandably) work 7 days a week. Although in D2A discharge to awwww block beds they do have cover & admit at weekends.

And my Sw colleagues work weekends too - hospital social workers and community SEs SWs are always being asked to do overtime (after a full on week working to 8-9pm some nights) to cover safe hospital
You know we are tired having covered a out of (mostly unpaid big sometimes paid) extra shifts throughout void last 2.5 years now to facilitate weekend discharges

But I do like to see my children and to sleep. Clean my house etc. however my hospital colleagues already work a 7 day pattern.

The total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2019/20, while the number of patients treated has increased significantly.

And we wonder why the NHS is struggling.

They're us a lot of effort to keep people in their gives partly because it's cheaper than 24 hour care and partly because it's better for them to be in familiar surroundings. It's not unusual for elderly people to go downhill very rapidly if moved, even more so if it's against their will.

And frankly their wishes should be taken into account, rather than be treated like children. For example, personally I think it's horrendous when married couples are split up because of differing care needs. Every effort should be made to keep people together if that is what they both want.

Most of the local rehabilitation unit were closed in the name of care closer to home! There is shortage of therapist/nurses/doctors. Step down beds ( residential/ care homes) cost fortune to local authorities. Local diagnostic centres are in progress but have no rehabilitation/ short stay beds. Clinical staff are not part of the decision making even though they are always invited to the meeting/ seminars as a tick boxing session. It’s so frustrating that someone in their high rise office decides how winter pressure money should be spent………crazy and expensive