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?

@Cuppasoupmonster
What do you think the answer is?

The answer is admitting what’s in front of us: a lot of people spend decades - not years - needing 24/7 care of the severely mentally and physically disabled cos no one dies from traditional causes any more.

But we don’t exactly live either - millions can’t cope alone and need carers. Esp in big houses.

Build nationalised care homes and plenty of them. Incentivise pensioners to downsize. Tell the truth - we aren’t paying enough in to cover the phenomenal costs of our own eldercare. The current generation paid even less, so I’d be tempted to raise inheritance tax as a care levy.

Be tough - if you’re a female with elders expecting free care, get a job and get them carers. Don’t ruin your life for zero reward.

I'd just like to add I'm furious that all governments fail to realize when they promise nurses and doctors that (a) this is 5-12 years of training (b) they pay for that training (c) they no longer have many hospital places to stay so they pay private rent which in many areas is extortionate.

I would also criticize Gordon Brown for going the route of PPI - basic private finance initiatives which meant hedge funds put up money to build hospitals and schools which then had to pay rent on the buildings and in some cases land. No one read the small print. So you have hospitals mothballing wards because they can't afford the rent and can't afford the staff.

Reframing attitudes won't solve the social care crisis.

And I don't think most people do think hospitals are best placed to look after people once they are clinically ready for discharge.

You make it sound as if people are being incredibly demanding about what they expect to be provided at home before they leave hospital. The reality is most people are desperate to leave hospital but would like to know they will be safe when they do.

Social care requires decent investment, and yes, higher taxes. Post Brexit, we also have a dearth of care workers.

Some relatives flat out refuse to help relatives return home. They don't want them and they don't want them in a care home eating up 'the inheritance'. Sadly some see relatives as money for the future and don't want to waste money on care or do it themselves. Free hospital staff because 'well there isn't enough care homes/care staff/I can't do it'.

Move them into care homes and them fund from house sale. Stop blocking beds. There are spaces in care homes but expensive ones which people don't want to pay out for out of the house....inheritance. Sod the elderly relative though.

It doesn’t solve the problem of the elderly who can't care for themselves but I was glad to see my local council publicising means of "help and support with daily living". "Daily living equipment and low cost assistive technology can help with everyday tasks and support people to manage their own health and stay independent and safe in their own home." They're even suggesting them as Christmas presents!
www.staffordshire.gov.uk/Advice-support-and-care-for-adults/Help-and-support-with-daily-living/Help-and-support-with-daily-living.aspx

This! among other things is a huge factor. I work on elective/emergency surgery and nearly half of our beds have medically ready patients. Some patients really need help to go home but wait weeks for care packages, some refuse to leave hospital until they have everything they feel entitled to, some relatives are suddenly unavailable to take their relative home as house needs deep clean, going on holiday or they just don't believe their relative is ready.

I see fit elderly who have catered for getting older/downsized/ got cleaners, set up online shop etc others have just let everything get so bad that they cannot possibly go home. Some patients are admitted from assisted living or nursing homes and they refuse to accept them again.

We are so short of social/community carers due to the poor pay/conditions and treatment of staff through covid that we have no resilience left. There is not enough rehab/discharge to assess beds or interim beds. I feel we should not have scrapped the NI increase, I don't really want to pay more tax but this is impacting the working of the whole NHS.

We have elective surgical patients who cannot get surgery due to the amount of beds taken by medically fit patients, who, don't need skilled nursing care, they need what we cannot give physio, therapy, help to get to the toilet and eat.
These patients tend to be resource heavy but not have high medical needs. We don't have the staff to cater for this level of need.

The government do not care about this as it won't affect the rich. It is a ticking time bomb

@notanothertakeaway "Bed blocker" is a horrible phrase
If someone cant leave hospital because there is no care package in place, that's not the patients fault

I agree.
They are not 'bed-blockers' they are 'delayed discharges'

To answer another person above - some people are incredibly demanding about what they must have in order to leave hospital - send them home - relatives should step up but in today's society it's down to everyone else but the relatives. They take the inheritance though when it's going but no responsibility or care it seems.

@dollyblack
£4k a week? That is a crazy level of nursing home funding are you sure that's not monthly?? Bc whaat?

As a social worker my question would be has a CHC (continuing healthcare) assessment been carried out by his local nhs (CCG now ICB) as funded nursing care nurses who work for local health commissioners if they are proving Dundee be using card (FNC) element of funding should be regularly reviewing against CHC criteria at least annually increase in needs ( ie CHC checklist then full CHC assessment via DST)

Anyway here are weblinks to Gov info-
www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool

www.gov.uk/government/publications/nhs-continuing-healthcare-checklist

@Notesfromtheunderground

Sometimes they are incredibly demanding.

🤷‍♀️

@dollyblack you said she is paying £4k a week? Self funding?

When I started working as a carer before I did my nursing I couldn't believe some of the conditions humans are left in. Bed bound with contractures , you couldn't even put a pad on them anymore had to use puppy pads as the muscles were too stiff to move. They had no interest in eating or drinking but we had to force puree and build up drinks while this person had tears. I've never seen such sorrow. I would implore people to do an advance directive while sound of mind.

Years ago families looked after their elderly relatives and in some cultures they still do. Not in greed ridden modern Britain though.

And in turn, the funding has to be moved from hospitals to community settings.. the vast majority of healthcare is provided in the community for about total 20% of the funding. Primary care gets about 10% of the funding, community nhs care about 10-12% (from 19/20 figures), for around a million GP appointments per day, plus however many community (physical and mental health) services appointments. Social care gets even less. Imagine if even another 10% of the funding moved to the community (for health and social care) what could be achieved and how many people would avoid admission or not end up stuck in hospital waiting for their needs to be met in the community.

As it is, the NHS funding is focussed on hospital care, and there are patients who end up stuck in a hospital bed (who lets face it, would much rather be in their own bed, with the care and equipment they need to meet their holistic needs), through no fault of their own.

And even if people are willing / able to pay for social care, at the moment, it's still pretty difficult to find because care agencies don't have the staff to be able to provide it.

@Battlecat98

Yup.

The old convalescent homes where those who aren't well enough to go home but don't need the actual nursing care do have their place

There is also, at least at times, breakdowns with communication - when my father was admitted with pneumonia they wanted him to go to a hospice, after several days of waiting for a hospice bed someone mentioned to my mother that the reason for him going to a hospice was because his bedroom was upstairs (I think it was a throwaway comment about it being a shame they didn't live in a bungalow) she said noone had told her that was the issue - that night a bed was brought downstairs and put in the dining room and he came home for his last 3 months

Sorry
"Dundee by using card " was actually funded nursing care!
Gosh I hate my phone!

I've seen this too - the level of greed and entitlement from people who can actually afford to pay is a problem

"BirmaBrite · Today 19:48
I see a lot of people who have too much money to be able to receive free social care, so they simply refuse to pay for it. They then reach a crisis point, get admitted and get discharged with free care for a limited period of time, when it comes to the point of that care ending and needing to organise social care, they then refuse because they don't want to spend their money on it. And nobody can force them to spend their money on care, so they gradually deteriorate again and then get admitted and then the whole cycle begins again, or something awful happens and they end up needing a residential or nursing home placement so all that money they thought they were protecting disappears."

@Iliketeaagain

Imagine if we just actually funded it all. Properly?

🤯

There is a service in Yorkshire that is currently saving the NHS millions and preventing admissions to hospitals. It was recently on twitter.... The government are aware of it, it should be rolled out across the UK.

I'd also suggest that viral wards need to be rolled out and society need to accept changes within the NHS.

Many patients still believe they NEED to see a doctor, however not only is this not possible but it is also not always required.

I would also suggest that care staff need better working conditions and pay. They would benefit from an increase in training and less red tape. Care staff know their clients, with an improvement in training and knowledge, along with more time they can support people to remain independent, help to reduce falls/mistaken medication/pressure sores/missed early signs of infection/ect. This would help reduce hospital admissions and help free up beds

Instead of throwing money into the nhs put it into social care it will make a massive difference. Iv recently spent a month in hospital and the 3 others in my room where physically fit for discharge but had nowhere to go to meaning people waited longer in a&e for a bed and people waited longer outside in ambulances meaning people waited longer for ambulances to arrive. The problem is as clear as day

Yes that is the term

100% this - they need to be forced out and forced to pay for their own care. The NHS is not social care for people too tight to pay for it when they can do so.

"Cuppasoupmonster · Today 19:40
cptartapp · Today 19:37
I was the only patient in a four bedded bay recently not there because of social issues. Two of the three very elderly frail women were absolutely insistent on going home as they 'could manage'. They could barely get across the ward unaided!
Repeat falls and admissions and bed blocking waiting to happen.
PIL failed to plan for old age and insisted in staying in a three bed house with stairs and no downstairs loo. One nasty fall left MIL a bed blocker for a while. Pots of money. Won't spend it, wouldn't plan. Repeat x 10000.
My mum (a care worker) says this. Many of her patients fall about, constantly in and out of A&E, only to insist on going back home again and won’t entertain paying for further help. It makes me quite cross actually. One patient she had lived in flats, every time the paramedics arrived they had to break down the communal door as he couldn’t remember the access code. It irritated the other residents no end."

Chin up, girl! Your experiences are valid-thank you for sharing.