‘The NHS is still proving incapable of dealing with its own long-term ills ’
- Credit: IAN BURT
The NHS dislikes the phrase bed-blocking. It prefers, instead, the term 'delayed discharge' – but whatever its label, it is an open sore to the NHS which will not heal.
The terms encapsulate the scenario where patients are stranded in hospital beds, awaiting discharge to continue their treatment journey – either at a specialist unit or in the community – but that onward course is not immediately open to them, due to lack of resources or facilities.
The term 'bed-blocking' is unsatisfactory in the way it infers the problem is the patient's fault, that they are the ones blocking the bed meaning it is not available for the next patient to occupy, whereas it is clearly not their fault.
Most patients who are in this situation find it a frustrating, demoralising limbo – perhaps even a purgatory – that they cannot embark on the next phase of their journey toward recovery or begin to make their way home.
Latest figures show that delayed discharge is costing the NHS in England £900m a year.
But this, like many of the issues having a negative impact on the NHS at present, is not a new problem. Almost 10 years ago, as the EDP's health correspondent, I recall reporting on how 10pc of the 987 beds at the Norfolk and Norwich University Hospital were blocked by patients waiting to leave… frustrating for hospital managers but even more painful for those wanting to get on with their lives.
At around that time, Norfolk's historic community hospitals, and their cherished beds, were being closed. Despite subsequent NHS reforms and restructures, the same old problems seem to be cropping up.
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We are in the midst of a GP crisis, with too few doctors and many retiring without a new generation in sight – nothing new there. We are facing blockages at A&E departments with waiting time targets being missed – nothing new there either, though it seems to be getting worse.
We are seeing ambulances queued up to deliver patients to emergency rooms, a problem also getting worse.
The main thing we have learned about the NHS over the last few years is that it is good at identifying problems, yet has a deep-rooted inability to solve them, or at least offer long-term or permanent solutions.
There appears a lack of joined-up thinking, the unwieldy elements of the health service do not seem to be cohesive – that there is a gulf between primary and secondary care, and caught in the midst is the patient.
This does not detract from the hard work and excellent care being offered by staff and at individual units, but that is being undermined by these ongoing, broader, problems.
The NHS will never consistently be able to deliver the best service to the patient until it adopts a more cohesive approach and begins to get to grips with these long-term issues.
There have been attempts to solve bed-blocking in the past.
A few years ago, three of Norfolk's MPs – each of different political persuasions – joined forces to organise a 'select committee-style' session to tackle the issue.
Liberal Democrat Norman Lamb, Labour's Ian Gibson and Conservative Richard Bacon quizzed hospital, primary care trusts (the predecessor of the current Clinical Commissioning Groups) and social services chiefs to attempt to find a solution to the problem.
Yet more recently, research by the EDP revealed bed-blocking is still an issue at Norfolk's three biggest hospitals and West Suffolk Hospital, having risen by 45pc in the last four years.
Nationally, official statistics suggest about 5,500 patients a day are affected with estimates that as many as 8,500 beds in acute trusts are being blocked.
Earlier this month, another eastern region hospital unveiled steps to address the bed-blocking problem. Papworth Trust near Cambridge opened a £2m residential scheme of 28 purpose-built, self-contained flats designed to bridge the gap between a hospital stay and discharge by replicating a resident's home, providing each patient with more than four hours of social care and one-and-a-half hours of occupational therapy every single day.
It may be a success – let's hope it is – and a step in the right direction. But those campaigners in Norfolk who a few years ago attempted to save community hospitals and facilities may well be thinking that such a resource, or infrastructure to create such a solution, was in place with the county's cottage and community hospitals.
Of the new initiative, Papworth Trust chief executive Vicky McDermott made the point that 'One of the biggest challenges in our current healthcare system is people returning to A&E after they have been discharged from hospital without appropriate rehabilitation.' So, could this even be a solution that kills two birds with one stone?
Elsewhere across the UK at present, another fascinating initiative is under way within the NHS called Test Beds, pilot schemes which look to embrace technology and cohesive thinking with multiple partners and agencies to deliver better care to patients.
One facet aims to deliver better treatment management for those with long-term conditions.
These are admirable and with great potential, yet unfortunately the NHS is still proving incapable of dealing with its own long-term ills.