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?

No you’re not clear you’re alluding to basics,with that in mind I cited routine surgery . A hip replacement is really straightforward with good outcomes. I chose it specifically as a routine , basic for want of a better word
So if you’re not undertaking treatments and/or surgery costing £100,000s where the individual won’t live long is that a universal rule, or just for older adults? What about children and babies with life limiting conditions do they get denied costly treatment, given we know that the outcome is a death in a few years

In fact All interventions are clinically assessed and offered in accordance with national guidelines and clinical pathways Overall outcome and efficacy determine the intervention

anyway, please do elaborate what is back to basics? What are you not offering

And it feels like the NHS is saving lives that probably shouldn't be saved

Shouldn't be saved? and what's your criteria for that? frankly I'd rather the NHS did operate on the basis of need rather than have a health service that decides that I'm not deserving of treatment because of some arbitrary criteria like being over a certain age. Because that's what you're getting at, isn't it?

Sorry can you not read? In my first post I said 'I'm not talking about routine operations here, I'm talking about operations that are costing hundreds of thousands of pounds'. A hip replacement doesn't cost hundreds of thousands of pounds so I'm unsure why you think I was referring to one of those?

No because I referred to an example involving a child in my second post. I didn't realise I needed to do an example for every age to avoid being accused of ageism.
It would be fantastic if everyone could be saved. But they can't, that's life. And imo that's part of the issue. Until the day comes that money is no object relating to the NHS then shouldn't the focus be trying to treat more people. If you can do 20 routine operations (for example a hip replacement as another poster used this as an example) for the same cost as it would be to do a complex surgery on one person then it needs to be looked at. Is 1 persons quality of life more important than those other 20?

The NHS did used to make judgements about who was worth saving, in the days when Drs were Gods. Lots of premature babies were not given treatment as the judgement was they were a high chance they would be severely disabled. Many d

You’re all over the place and habitually declining to elaborate what is basics?
Who is not getting? What will basic NHS actually look like.
You have no clear or though out logic just some random points about basics and who shouldn’t be treated.
Now you’re touchy because you cannot explain your own rationale

Are they talking about a system where you get emergency treatment but nothing else?

The majority of people do pay social insurance. It’s called National Insurance (NICS). And what if you don’t have a house to sell, a large pot of savings and family who live a long distance away or who downright refuse to help? What happens when any savings you do have run out? A lot of assumptions being made here.

@Zone2NorthLondon I'm touchy because I'm thinking there's no point replying to someone who doesn't read a post.
Anything out the ordinary. I can't list everything I think should be done so I'll just list off some examples. So normal cancer treatment, removing tumours/growths, chemo, radiotherapy etc. Ordinary organ transplants. Broken limbs. Emergency operations (such as blockages, heart operations, shootings, stabbings etc). I know I'll have missed a load off but hopefully you get what I mean.

I've got another example of what I think shouldn't have been done on the NHS and this is close to home. Nearly 20 years ago my grandad was diagnosed with advanced mouth cancer. He had to have a complex operation on the NHS, his consultant told us at the time only 3 hospitals in the country offered it. They basically had to remove half of his face, his jaw and his tongue. His jaw had to be rebuilt, and he had to have a skin graft off his back to be put on the bottom half of his face. I was a teenager, I remember getting up for school at 7am and the hospital had called to say he was in surgery, and going to bed at 10pm and he was still in surgery. 17 hours it took for the operation to happen. It was successful, the cancer was removed and after a bit of radiotherapy he was fine. Except he wasn't. He had no quality of life. All food had to be blended and he was on those shakes. He didn't go out as he was self conscious (you could tell - skin on your back is a lot different to the skin on your face). He passed away just over 10 years later. At the time we were all for the operation. Looking back those last 10 years were a waste. He didn't want to be here, he was caught towards the end pouring his shakes down the sink. An operation that we were told cost hundreds of thousands of pounds and it was a waste. So no I'm not being heartless. I just can't see the point in existing and not living and in some cases that's all these sort of operations will be doing.

@Janiie - unfortunately, even if there is a full care package in place, if the elderly person goes into hospital, that care package is cancelled, and has to be put in place from scratch, when they are ready for discharge. There doesn’t appear to be a facility to pause a care package when the patient goes into hospital (although they can pause the care package to go on holiday - go figure).

I have a friend whose mum stayed in hospital weeks longer than necessary because her care package was cancelled when she was admitted, and had to be remade, from scratch before she could go home. This lady has an illness that means she has ended up needing emergency admission to hospital at least twice in recent months, and every time, her care package is cancelled, and she ends up waiting in hospital, when she is fit to go home, because her care package is being re-established.

Making it possible to pause her care package would result in her being able to be discharged promptly, rather than blocking a bed.

no I don’t get what you mean it’s it’s tangential waffle. You’re all over the place
ok so to you basics is emergency & routine, no enhanced or innovative practice
do you understand that costly innovation becomes routine over time as staff undertake procedures , get skilled at treatment and what was once offered only at regional specialist units become more accessible

you're really not explaining nhs back to basics or how you’ll implement it
who are the decision makers when treatment is at cusp of non basic? The accountant? The finance director? The doctors?

There doesn’t appear to be a facility to pause a care package when the patient goes into hospital (although they can pause the care package to go on holiday - go figure @SDTGisAnEvilWolefGenius

You simply notify the providers and LA to amend the purchase order .Good practice is notify the provider and pause poc until discharge

restarting the poc will obviously require notice and may cause a dtoc

most areas are experiencing issues with lack of staff to undertake poc provision

It may be different in different areas, @Zone2NorthLondon, but my friend’s mum’s whole care package was definitely cancelled, not paused, each time she was admitted to hospital, and had to be redone from scratch - resulting in her being in hospital weeks longer than necessary.

@SDTGisAnEvilWolefGenius

The policy (in our trust) is a poc will be held for 7 days.

I agree. It was not long ago that stents were innovative. Now a totally routine operation.

When I worked in a front line role, we had a lady with us for 12 weeks who was ready to go home. I won’t say why she couldn’t go home but it was frustrating for all concerned, let’s put it that way. She was there at least 9 weeks longer than she needed to be. That was probably the worst one I saw but there were loads more of between 2-6 weeks.

I have had relatives in this situation. They needed carers and in some cases home adaptations. Even if they were paying for it took time, as does finding a care home. There need to be interim convalescent homes that only provide social care while measures are put in place.

It would probably take 2 weeks max for any convalescent home to be full. Then you're back to square one - and the convalescent home has poached staff from other services.

It's a very sad situation, but something definitely needs to be done. It's not right that people are dying from lack of medical care while people who don't actually need that medical care are taking up the beds. I think maybe a national care service is needed, to run alongside the NHS. Although that will mean a big tax increase.
I do think as well that a lot of elderly people could do more to help themselves. I know in my own family of a relative who should have accepted care but categorically wouldn't. Unfortunately care would have saved her life when she fell and family didn't find her until the next day..Also other relatives in their 70s inherited a large amount of money when their parents died and decided to upsize to a 5 bedroom house. How exactly are they going to be able to maintain that house in 10 years time? It seems like an accident waiting to happen to me, unfortunately.

Adults are allowed to make unwise decisions whatever age they are. No one stops a young person buying a house they can not maintain, or a young person with a progressive disease buying a house they will not be able to live in in 10 years time. People make bad decisions all the time.

We need a reform of social care. The private sector running such an essential service has been a disaster. Local authorities used to run care homes and teams of home carers. Staff were better paid and better treated.

Private care homes should be at the luxury end only and public sector care homes at the basic but decent end.

Local authorities now mostly charge for home adaptations. I understand the reasoning, but I wonder if it has made many reluctant to make adaptations at an earlier stage.

Of course adults can do whatever they like with their own money. But the more adults who buy 'forever' homes which are totally unsuitable for them when they get older, (and honestly how could 2 people need 5 bedrooms?!) the more of a problem we are potentially building up for future care needs.

Yep. All of the very large old properties in the rural village where I lived were occupied by elderly couples or singles, not families. The houses then fall into disrepair as they can’t keep up with the maintenance but don’t seem to want to draft anyone else in to do it, and just end up living in a few rooms.

I do wonder whether part of the problem for elderly people, when it comes to downsizing, is the sheer enormity of the declutter if they have to do, to go down from a 4-5 bed house to, say, a 2 bed one.

Most of us use all the space we have, and as you get older, you do accumulate more and more stuff, and it is a massive task to sort out a big houseful of furniture and other stuff, to make it fit into a much smaller property. I’m not elderly, but I quail at the thought of the drastic decluttering I’d have to do, if I was downsizing, so it must be much more daunting to someone elderly.

My mum had to downsize from a fairly spacious 3 bed bungalow to a much smaller 2 bed, and she did not manage to get rid of anywhere near the amount of stuff she needed to, in order to fit comfortably into her new house - the living room has two bookcases and a dresser, plus a dining table and chairs, a coffee table, the TV and two easy chairs, and the other rooms are almost as cluttered, plus there is a lot of boxes in the loft.

I can easily understand why elderly people would choose not to have to do that huge decluttering task, and just stay on, using a fraction of the space they have.

I’m not saying this is right or fair, but if we understand why people might be reluctant to move, maybe they can be offered help with whatever is putting them off moving.

After having dealt with my DPs belongings after they'd died
and also an aunt's I decluttered my stuff. Unfortunately DH doesn't and is a bit of a hoarder. But decluttering is lovely - like a weight off your shoulders.

Miantenace is expensive. Dealing with tradespeople is hard when you are vulnerable. Loads of elderly people get ripped off. Even more are asset rich and cash poor.

And yes moving as you get older becomes too big a task without help. I am in my fifties and even at my age I find the idea of moving overwhelming.