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 wasnt talking about A&E I was talking about 3am discharges from wards which have been documented on here in the past.

Ohhh you didn’t specify that did you? Gaslighting much 😉

That’s what all the rest of us were talking about too. Particularly since there are no beds in A&E - just trolleys.

Ahhhh now you tell me… 🙄

Of course there are beds in A&E, or trolleys or whatever. And people get discharged from them throughout the night every night. Including elderly people.

I don't think our local A&E has enough chairs, let alone beds/trolleys! It's surely rare to have discharges from wards at 3am?

YY @Blossomtoes exactly The only one that didnt realise we wernt talking about A&E is the OP

There are no beds in A&E.

And you can’t be discharged from A&E because you’ve never been admitted. Discharge is only from wards.

Discharged from a trolley then. Although I’m not sure what difference that makes 😂 seems you’re falling back on pedantry.

then why do I have papers clearly labelled ‘discharge papers’ from my trip to A&E where I was diagnosed with diabetes? I wasn’t admitted to a ward, I was sent home with my diagnosis and emergency meds and had outpatient appointments after that.

Given that family Carers save the NHS so much money each year I really don’t think it is impossible to devise a scheme where more people who want to step up for their family member can do this without the huge financial impact it entails. I provided24/7 care for my severely disabled son for just £65 a week Carers Allowance . I worked alongside a care agency worker’ she was paid just over the minimum wage each hour whilst the care agency received £22 an hour.
if someone just needs meals prepared they can get food deliveries which just need heating up and for company and stimulation they could attend a day centre. It is when they need help with feeding, washing, dressing, mobility , medication etc that a better system is needed to keep them safe and out of hospital so that beds are feed up

This is the funny thing on this thread. The OP is assuming that carers will be quick to classify themselves as a carer, when the opposite is true. It takes an average of 2 years for a carer to recognise they are a carer.

Even if carers provide lower-level support (which will still feel relentless and make it harder for the person to work, have holidays etc), they are holding responsibility for their loved ones care. A carer will support someone to access health care via primary care, this will keep the person in their home longer which saves huge amounts in local authority residential care costs. They will also help avoid admission to hospital. It's been made pretty clear on this thread we don't have acute beds, and when we do it's at least £400 a night.

Carers save the economy 530 million a year, we need to value them and value care as a whole.

All the time. There's very often some poor sod at 3am waiting for the bed.

I do think it should be possible to devise a system which targets first those patients who are frequent attenders at A and E because of the complexity of their needs and the stability of their health condition. With the appropriate family, community and GP support the risk of them attending A and E and staying longer than necessary in hospital can be reduced. The training and experience of a fully supported family Carer can be the key to this.

The solution is funding.

Funding carers allowance at a decent rate so that a family member can afford to do it if they are capable and want to do so.

Funding social care staff wages so that it’s a job that people can afford to do as a career choice rather than a “shit ive no job… become a carer” or “what works round the kids… become a carer”. This will cover the people who don’t have family who can and those who need more care than family can offer.

It would take wedges of funding to begin with, but I’m convinced in the end it would end up on a par to what is spent now - just in different ways.

I was talking to dh about this yesterday, and I said that the rot started back when I was nursing (I trained in the 80s). Back then the government were closing beds, and closing whole wards, in order to be able to save money on staff costs.

Not only did this mean that there were fewer beds available for patients, but the NHS work force shrank. I think it also meant that fewer nurses were trained - when I trained, the hospital I worked at took in 6 intakes of 30 RGN student nurses per year, plus intakes of similar numbers of SEN nursing students (though that stopped after my first year of training) - and as far as I know, most hospitals of any size had Schools of Nursing - but as capacity fell, I bet the hospitals trained fewer nurses. I wouldn't be surprised to learn that the number of nurses training fell further when it became a degree course.

All this has meant that there are fewer nurses now - so even if the government started building convalescent homes or cottage hospitals, which could offer the step-down care from hospitals that would free up beds in the more acute care areas, where would they find the nurses, physios, doctors etc to staff them?

Basically the NHS has been cut back until it is barely coping with the day to day demands, so when higher levels of demand happen - like every winter, for example, or a crisis like Covid, it is stretched to breaking point, and patient care and staff morale suffer. And staff morale suffering leads to people leaving the caring professions, which only makes staffing levels worse - it's a vicious circle.

We need more nurses, doctors and other healthcare professionals, and we need more capacity in the NHS, so there is spare capacity to cope with crises. And I don't see any government or political party indicating any willingness to spend that sort of money.

The working and pay conditions of paid care staff need to be drastically improved. Some of the paid care staff I worked alongside could earn more at the large supermarket nearby. Their care working contracts specified a standard 12 or so hours a week but would not guarantee them more hours. It was difficult for them to plan their lives and I felt there was competition among the staff for additional hours. There seemed to be little distinction between the pay of new and experienced staff . There needs to be a proper career structure for Care workers so that senior care staff who have experience and specialist knowledge are appropriately rewarded. I had the privilege to welcome many dedicated and skilled staff into my home, such wonderful people who are woefully undervalued by society. It is a job that requires some exceptional attributes

Just to add that many of the care staff were working for more than one care agency so as to be able to get enough hours each week. It is no wonder recruiting and keeping community care staff is so difficult , their employment terms and conditions were very poor. An overhaul of the Care system can be a major approach to unblocking beds in hospitals.
Sometimes I think it is because Care is seen as a women’s domain that the male politicians ignore it. It is their wives who do the Caring, who visit elderly relatives in Care homes , who volunteer in the community. . It is not on men’s radar hence some of the mistakes made during Covid .

The problem of Delayed Discharges could be alleviated if someone could sort out the Internal Market by allowing easier transfer of funds across departments.

An elderly relative of mine was admitted for a minor procedure. All went well. Unfortunately she banged her toe on something and it caused an ingrowing toenail that was very painful.
After a course of antibiotics and another week in hospital it was no better.

The Podiatry Department was actually down the corridor, so I went and made enquiries. I was told that the Podiatry Dept would happily treat them if
a) someone could wheel them down to them and
b) if funding could be made available.

I spoke to the ward sister who said the Podiatry Dept had a different budget and there was no method to Via between budgets. So there was no way for the hospital to reimburse the Podiatry Dept for this procedure.

I asked what was to be done and was told that my relative was waiting for a slot for theatre to remove the whole toe-nail, and this could be weeks as it wasn't urgent. ( ! )

I did contact some private Podiatrists who said that they would not be prepared to perform the procedure on a ward because of the lack of privacy and danger of infection.

Eventually my relative contacted their own GP, and another GP from the practice who was trained in minor surgery came and sorted it out in 5 mins after giving a local anaesthetic.

This, IMO, was a ridiculous situation that could have been avoided if managers had more flexibility with their budgets.

We need to give some serious thought to assisted dying in this country because a lot of people me included would not want to live with dementia in a hospital ward and would have opted out long before this. That doesn’t help the people trapped in the system now but could reduce numbers in future generations. I would go for it and I know my parents now with dementia were keen on it also.

@Broomsticksandbedpans I agree, that would be helpful.

I could not agree more. Personally, the whole of the rest of my life would feel better knowing that assisted dying would be available at the end.

I trained as a nurse in the early 80’s, at that time we had to work in the two cottage hospitals as part of our placements.
Each cottage hospital had 3 wards of approximately 30 beds each, one hospital was purely for EMI, people with various stages of dementia.
The other hospital was mainly for people who had previously had strokes, hip replacements etc and was used as a rehabilitation hospital, getting people back to as good a state of health as possible, before discharge to either home or a residential or nursing home.
Both hospitals were run by matrons and nursing staff/hcp’s. Occupational therapists and physio’s visited daily to assist with rehabilitation. Doctors also did ward rounds to check on the patients.

Just as I qualified, they closed both cottage hospitals down, at a loss of 180 beds. The wards at the main general hospital became carnage, people with dementia trying to get into bed with people who very ill and connected to i.v. drips etc.

No rehabilitation for people following major operations, strokes etc. Recurrent admissions due to not being able to cope at home, no physio or o.t. to assist with transfers to home to ensure people were able to manage at home.

This was not utopia on the wards, but was more manageable.

I feel we desperately need this type of care, to free up beds for people who are desperately I’ll and who are in corridors and ambulances not getting the care and support they really need.

More convalescent places;there's only one for the whole of county where I live and it's not particularly big;this is place where patients who aren't Ill enough to be in hospital but can't return home yet go.

The biggest issues with bed blockers is the lack of onward care and the time it takes to arrange it;I think it's fair to say many bed blockers are elderly and they often either have to go into a care home,move care homes as the one their in can't provide the care they need anymore or need home help/carer visits arranging.It's a very long progress that needs to be sped right up.

The only solutions that don't cost more in taxes are:

• people care for their own relatives at home (as is the common model in other countries). This is only really possible where there are none or part time workers with capacity to provide "free" care

• change perceptions about the extent to which it is reasonable to provide extensive professional care to prolong the lives of very elderly & frail people