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 wholeheartedly agree with you.

@Frootlepootle

Lol

Whats your experience of the nhs, care system or public expectations of either?

People want to be kept alive at all costs On what evidence do you say that?
I don't and I expect there are many like me.

100% agree! I'm constantly asking our gp to rationalise meds as they are always excessive.

Why do we insist on keeping our elderly dying patients alive, my father knows his medication keeps him alive, he doesn't want to take it anymore. He has all his faculties but his body is done, he is tired and can't understand why the Doctors won't let nature run it's course.

This is absolutely unacceptable. You poor thing. My blood is boiling reading this. Hope you are feeling better. The politicians who have allowed this state of affairs need to hang their heads in shame.

well he doesn't have to. Even patient lacking capacity have the right to refuse.

What were their plans for coping as they aged, 'miles from family'?

What do you suggest they do? Get one family member to give up their jobs, uproot their children, leave their in laws and return from New Zealand? Or get the other who has an auto immune disease to be their career, despite needing care themself? They live in a one bed flat so have no 'downsizing' to do. They did the caring for their own spouse before their death - now they are alone. Bright as a button, fully compos mentis but has just had major surgery and cannot get around independently. They are 'buying in' as much care as they can - but funds will run out soon.

What else do you suggest they do?

Remember, many old people do not need 'extraordinary' care as they age. For those who have the financial ability to make advance provision for their care in old age ie move into 'retirement villages' with on site care - let's not pretend that is open to everyone.
Some 'bed blockers' (vile phrase) and young people who find them self unexpectedly in need of 'extraordinary' care. What provision could they possibly have made?

Let's not drive our country into abandoning the NHS.

Bed blocking is not a new problem , I stopped working in the NHS nearly 10 yrs ago and it was an issue then . I know it’s not a popular opinion but I think the problem got much worse when they did away with the big old psychiatric hospitals and the cottage hospitals that dealt with a lot of elderly care .

@Anonymouseposter

Lots of experience in healthcare

It's certainly not all people.

But yes. I'd certainly say the nhs is a victim of its own success that the tories have now destroyed.

@iwasabedblocker In fairness the overwhelming majority of bed blockers are elderly patients waiting on a nursing home place and not young trauma victims like yourself. I really sympathise with your situation and it shouldn't have happened.

We need to stop pumping the elderly full of every medication going and doing ridiculous surgical interventions on them. I sent an 82 year old for a stent post heart attack a few months ago.

I witnessed a junior reg do a femoral stab (very invasive procedure) to get blood from a demented 93 year old who was having a massive heart attack on the ward (she died 30 mins later)

I regularly have to pressurise doctors to complete DNR forms for patients who are actively dying/demented/have a list of illnesses longer than my arm.

I have no idea why as a society we are so afraid of death. I couldn't imagine anything worse than living to that age and not even knowing who I am never mind being completely incapacitated and then my children beg medical staff to keep me alive at all costs.

this…

MandalayFray · Today 19:12
Having centrally funded care homes, not private businesses

Paying carers a good wage so people actually stay in the job, and the right people apply (as currently it’s seen as a job for those who can’t get anything else!)
Euthanasia

'Discharge' wards staffed by healthcare assistants/carers and run by a manager or social worker, so all the 'bed blockers' are in one place rather than spread out over the hospital with no one taking responsibility for the scale of the problem.

While we're at it, we need 'waiting wards' where ambulances can 'drop and run' minor cases (that shouldn't have called an ambulance in the first place) rather than queue to handover.

Yes I noticed this When my dad went in for respite care earlier this year. Plenty of spare rooms - found out why - absolutely shocking staff to patient ratio. We removed dad as soon as we realised how bad it was. Smelled of wee. Twice he had other patients' clothes (even underpants) on. I complained in writing to the relevant authorities as he was in danger there. Even worse, our then SW had recommended it. Very clued up now!

Create accommodation near the hospital grounds or in local authorities capable of delivering the short term care that people need before they return home.

Who have thought a comment with the word euthanasia would be the trigger for removal

Christ some people at @MNHQ need to get a grip

There are genuinely people with no family support in their location. To whom the state owes a duty of care. And they are being treated incredibly poorly.

Unfortunately the state only owes a duty of care if they have minimal savings, otherwise it is up to them to fund or part fund care. Some people choose not to, which is entirely their perogative.
Equipment like commodes though is an easy fix and if you lived in my area, I could have had one to you within an hour.

You see, we can't even talk about it. There is no hope 🤦‍♀️

I can tell you exactly what is causing this: social care is the poor relative of the NHS and does not get enough government funding which is ridiculous because it SUPPORTS the NHS by preventing bed blocking, thus reducing NHS costs as a result. If social care and councils adequately funded their care packages (which they dont), instead of paying rock bottom rates, then care agencies could afford to pay staff more and this in turn would attract more staff and fulfil more packages. The homecare association have looked into this issue and have suggested what councils should be fairly paying for their home care packages and they are not paying nearly enough which is why we are in this mess. Its a false economy because being stingy with their rates isnt cutting overall costs, its actually increasing them.

We have plenty of care homes where I live. One local hotel is now a care home. The problem is getting enough staff.

Yes earlier intervention will help. I have been there myself with my daughter. There's been a few times If she had been seen sooner she wouldn't have needed to stay in hospital. It's not only the elderly who bed block. But there has to be something better than keeping them in hospital. Which are also short staffed.

In our LA (I am an adult and Older adults SW) there are discharge to assess (D2A) beds with non chargeable (to service user) re ablement beds for up to 6 weeks in designated nursing homes with reablement MDT and social workers following up to manage that transition and transition after. Very proactive teams to prevent social care bed blocking but mostly aimed at keeping our clients independent as possible where we can

. We also have MDT (multi disciplinary teams) re-abling , and short term services and rapid response teams to get people out of hospital if not required and prevent hospital admissions . My LA (county council) is leader in these arrangements.

But sometimes there are people without capacity that are objecting without capacity under DOLS (MCA 2005) and it has to wait for Court of protection judge . That is so delayed and so slow a court process (up to a year) it is something legally we cannot make faster as it's a legal court requirement and I cannot comment. But ....

No one is delayed in an unnecessary hospital bed if we can help it as social care here.

A bit of occasional waiting gif a pAckage but we are talking days not weeks, our processes are so resp sure e and fast fast to go home with supprt or to a D2A bed or to a placement of that is certain and wanted .
Sometimes other factors delay it out if our control sometimes families argue amongst themselves, but believe me social care can and do work incredibly hard. At least my LA do.

I disagree that most elderly want to be kept alive at all costs. As PP said, their families are a different matter.

I feel a national care service is a great idea. I also feel there needs to be more rehab (convalescent or step down) hospitals and more state-owned care homes. At present rehab placements are being run through private nursing homes in my area with limited access to OT/physio input.

There needs to be more OT and physios for the above. In terms of the latter, there are loads out there, they've just gone private due to better pay and working conditions.

I do feel this should be uniform around the UK. I don't feel different trusts should have different paperwork, policies, procedures, uniforms, etc. It's inefficient and wasteful. Don't get me started on different software per trust...

I also feel 'the state owes a duty of care' rhetoric needs to be abandoned. This attitude is what is stopping a lot of people (who can afford it) from paying towards their care and disenfranchises family members who can help from doing so.

Along with the 'well, I paid my taxes' talk, which annoys the fuck out of me because most of us will have received more (education, healthcare from gestation, benefits, pension, etc) than we've paid in.

Now this is controversial but in terms of funding, I think we should crack down on those who can afford their own care but who weasel out of paying e.g. by transferring assets to family members in their old age etc. Recoup care costs from the estate once someone is deceased

Back to the argument - do you punish those who have put money aside and saved for their rainy day or old age while giving free care to those who have spent freely on the 'fast life' of foreign holidays, cars, lively social life, big families etc etc. Many have money in the bank because they have saved, not because they earned too much.

What will happen is that people who have 'saved' and lived frugally will shift their money to stop the government getting their hands on it. It's dangerous to punish those who have been saved.

If they earned more, they will have already been taxed more - we shouldn't take money from them twice over!

Are we going to deny other 'services' to those with more money - hospital care? maternity care? education? Or are we just targeting old people?