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?

What’s the issue with an 82 year old having a stent?

@hatgirl you have hit the nail on the head. Perhaps the reality of our time is up isn't widely talked about enough whilst we are healthy? I know it's morbid but it's the reality. I absolutely feel the same as you I don't want surgery at 80 odd.

The answer is to invest in social care. Pay carers a decent wage, treat them like human beings with decent pay and working conditions. Stop viewing it as an unskilled profession (a very popular mumsnet view) and entice people into the domiciliary care sector.

no care in the community is the main reason why I can’t get my patients out of hospital and back to their own homes. Sort out social care and the nhs will follow.

Religion goes out of the window when people lose their capacity. Or/are in pain . I've had many people begging to die or ask can I die now. It's horrible , I don't want that for myself.

There will never be enough money to pay carers what they should be paid in order to ensure there is enough social care. Social care is a black hole that swallows vast amounts of money. The elderly population is increasing and will continue to increase. Working families can't be expected to provide the levels of care that will be needed.

If it's bad now, it's going to get a lot worse. The government have promised more cuts and austerity as well. Council Tax will massively increase to try and cover the increased social care which will place yet more pressure on working families.

The additional problem is that most social care is provided by corporate businesses whose priority is to make money.

Most should be not for profit organisations, but I agree that carers should be employed by adult social care rather than ASC paying private companies to provide care packages. It’s a broken system.

But the first step is to sort out the huge shortage of carers who are out there. I don’t know how much longer we can go on as we are. It’s a huge issue every day.

I had to leave FIl in hospital. OH unable to help for health reasons. My job is patient-facing so there is no extra time off if I want to keep the job and you can't WFH. FIL is 4 hour drive away and has no other family. We cannot ask neighbours to help FIL with personal care and they are all in their 70's/ 80's - at least the ones we know. This may work for some but not many and the running of the country cannot be based on the assumption that this will be possible for all but a minority.

My elderly neighbour died recently after 6 months in hospital as they couldn't find a suitable care home to manage their dementia. They had a hear attack in a community hospital were revived, and blue lighted to the nearest A&E. Who the hell made that decision? Instead of dying quickly it was a prolonged, painful death that was badly managed. They lost so much condition in hospital they couldn't stand up independently, had dementia and were 95. Why revive them? I'm livid about it tbh. What a waste of resources and a horrible death. No-one wants to have the difficult discussions, but some of these people are so ill it's kinder to let them die than aggressively intervene in what is a natural process.

We've had that conversation with FIL. It's not us who have our heads in the sand.

Totally agree. Sadly we have seen this for years in A&E. it's really upsetting to put a patient through all of that when their prognosis is pretty dismal. Give them a peaceful dignified death.

I don't know how to get past it to be honest, the NOK is traumatized by the death and management in the hospital, and have been really concerned they should have asked for more sedation. It's bloody heartbreaking to be honest.

We have to accept we don't live forever.

Except the NHS isn't free, we pay into it our whole working lives. It's not crazy for people who have paid tax and NI for 50-60 years to expect treatment.

Love it 😹

Legally the paramedics have to unless there is a DNR. This should have been in place. Everyone I know who gets to a certain age has one.

@Janiie You seem to have little understanding. Relatives have normally had those conversation multiple times but the elderly relative is an adult and refuses to consider it. Spend just a few minutes on the elderly parents board on MN and you will see it is a common scenario.
And I do not even blame the elderly relative. Care homes are generally shit and getting good home care is exceptionally hard.

If we assess a patient as needing a hospital bed, providing our order is in by 1 pm, it can be delivered same day. However... most people needing a hospital bed will also need a package of care, which can take months to source, so we would normally order the bed on a 7 day order and upgrade to urgent if package of care is found more quickly than we thought.

'And I do not even blame the elderly relative. Care homes are generally shit and getting good home care is exceptionally hard.'

Care homes are not 'generally shit', what an awful thing to say. There are rules regulations and assessments and to ensure these places are not generally shit. Anyway I'm not talking about care homes I'm saying get the right level of support in at home and then if the elderly person ends up in hospital they can say oh yes I have a home help, meals on wheels, a stair lift, whatever so the poor hospital staff don't have to start from scratch to get things in place.

I'm sure there are people who try to get their relatives to seek help but there are also many, many people who do not and watch while the whole thing deteriorates expecting someone to wave a wand and organise social care. Then we end up with the disrespectful term 'bed blockers'.

But often people have no need these things until then. One morning 7 years ago my 76 yo MIL walked into town, met a friend to catch up over coffee, paid a bill at yhe bank, did some shopping and got the bus home. She had zero need of any help at all. That afternoon she had a catastrophic stroke and has needed 24 care ever since.

Yes of course some people have sudden catastrophic events but that can happen whether you're 76 or 40.

I'm talking about the 85yr olds who can hardly walk upstairs, the 80yr olds with mild dementia but no one dare get a home care assessment done as it will be awkward and the person still has capacity. Yes they may well do, but get carers in now doing a once a day meal prep or similar and then if you live 300miles away and don't hear from them for 2 days at least you know someone of a professional capacity is involved even at a very basic level, then more can be added to that to prevent lengthy unnecessary hospital stays awaiting a care home place.

In my DMs (ruralish) area the local hospital which had had A and E and several other wards closed down and turned into a convalescent/rehab home with an urgent care facility attached. This is such a good idea. There is a larger than average elderly population in her area. The rehab hospital means that people can be discharged from the big, regular hospital thereby freeing acute beds. Once at the rehab hospital they can concentrate on getting a bit more mobile/stabilising new meds and family and social workers can get new, long term care sorted out. It causes extra problems to discharge people back to homes without proper preparation like making sure they are accessible and there are reliable people able to visit.

This was an absolute god send after DM had a fall and a broken hip. The hospital were making plans to discharge her to home within days when she (and I) were totally unprepared. I am afraid I bed blocked by stalling on her discharge because I knew she wouldn't be safe at home and would end up back in hospital. I then heard about the rehab hospital and pushed for that.

Unpopular opinion but the NHS needs to be stripped back to basics more. There are things the NHS do these days which are amazing but we're at a point now that they're struggling to do the bare minimum. Me and DH watch that surgeons programme on the BBC. The things they do on there are out of this world but when it's being done on someone in their 70s/80s you've got to question why. I'm not talking about routine operations here, I'm talking about operations that are costing hundreds of thousands of pounds. If it's being done on someone in their 70s you're going to get what, another 20 years maximum out of that person.
Not all lives can be saved. And it feels like the NHS is saving lives that probably shouldn't be saved and those that need routine treatment are the ones that are passing away. They're letting say 20 people die so they can say look at the amazing work we did to keep this 1 person alive.

@mummyh2016 back to basics nhs?what does that even mean?Basic what?
The hip replacement for the older adult adds to their quality of life, keeps them independent in their community and able to be participative. It’s a procedure with medical and social gain. People are whole complex beings they cannot and should not be reduced to their age
what about procedures for young people/babies with conditions that are costly to treat are they unnecessary too. We spend millions treating conditions that will still result in an early death. Shall we stop that too? Applying your flawed logic why spend money Since they only have a limited time
we spend millions treating childhood illness that will result in premature death, according to you it’s not absolutely necessary

look at the individual as a whole person,consider treatment, quality of life and outcome. Don’t reduce an adult to their chronological age and dismiss their needs because their old.

I would class a hip replacement as routine surgery which I've said I'm not referring to. I'm talking about out the ordinary operations that costs hundreds of thousands of pounds. A quick Google search tells me a hip replacement costs approx £10k where I live. I thought it'd be clear it wasn't these sort of operations I was talking about.

@Zone2NorthLondon and it's not just age. There was a case on Hospital a while back about a child, the NHS paid for him to go abroad (Germany I believe) for an experimental treatment to see if it improved a condition he had. The costs were in the millions. It's sad but the NHS cannot afford to pay millions for treatment for one person which they don't know if it will work or not.
What I mean by back to basics is instead of spending millions of pounds on these new experimental treatments they need to sort out the core issues. Which at the moment is beds. If the social care crisis can be sorted it will free up beds which will mean ambulances will no longer be stuck at A+E and people won't have to wait 18 hours for an ambulance (happened to someone I know last week). I can't see how anyone can justify paying millions of pounds out on treatments that may not work when we can't even save people who have had a simple fall because an ambulance can't get to them quick enough.