Yesterday Mike Farrar, the Chief Executive of the NHS Confederation made the news by claiming that 1 in 4 patients in hospital beds could be cared for and could recover at home.
The difficulties of arranging appropriate discharges from hospitals is a matter that’s particularly close to my heart. Not least because I’ve been involved in the process for over a decade through my work. I’ve seen many changes (notably the Community Care (Delayed Discharge) Act 2003). Some steps forward. Some hefty leaps backwards.
And who are these ‘1 in 4’ that Farrar mentions. Well, unsurprisingly, he is referring to older adults.
The Guardian article says
One big issue is elderly care. Farrar said NHS leaders believed that at least 25% of patients in hospital beds could be better looked after in the community or could look after themselves at home rather than in the “outdated hospital model of care”.
With money short, there has been increasing concern that support for vulnerable patients from social care, paid for by councils, or from NHS-funded nursing in the community, has been cut back. The result is bed-blocking as patients face increasing delays in being discharged from hospital.
I have no doubt that better care could be potentially provided in the community but the block is very much services and more importantly access to appropriate services both from NHS primary care and from social care which are both being cut at the moment.
I have also over the years and in fact, quite topically, over this week, seen some appallingly rapid hospital discharges that have been rushed though purely on the basis of cost and pressure for beds. It is understandable when the pressure comes but the price that is paid for fewer hospital beds can be excessively high. A poor, rapid hospital discharge to the community with poorer and fewer resources available is a very costly one. The problem is that saving made by the NHS in the hospital bed being ‘freed’ is picked up by the local authority in terms of someone having an increased longer term need.
Yes, there are more quickfire ‘enabling’ home care packages intended to pick up the immediate hospital discharge but they tend to be focused on rehabilitation goals which are very much orientated towards physical care needs. My experiences have been that there are far fewer resources of a similar ilk available for people with dementias or those who have less ‘straightforward’ care needs.
I also find the tone of these discussions difficult. ‘Bed Blocking’ is an appalling term and I’m very disappointed that it is still used in the press and analysis because it implies there is a blame.
The blame for delays in being discharged from hospital is not usually on the patients themselves (although sometimes going home, especially if you are going home alone can be very frightening) or social services departments if the funding has been cut savagely or on the hospital which desperately needs the bed for more people coming in. There is a systemic failure in the way commissioning, care and health are disjointed and the eternal desire for one sector (health) to shift cost to another (social care) and vice versa.
And what good does charging local authorities for ‘delayed discharges’ do? It provides more cash for the hospitals.
The system currently almost aims to set up two competing demands of health and social care as separate. Until things work more cohesively, it is unlikely the best results will be met for patients.
As for providing more NHS care at home? That will need an increase in provisions rather than the decrease which I am seeing.
Of course not being in hospital is a good thing and receiving care at home instead of in an institution is a good thing but it has to be tied to
a) better access and availability of community health care as well as social care. District nurses as well as home carers.
b) better support for family (and friends) who are carers because I worry this will shift more responsibility to them without acknowledgement.
c) better planning of both health and social services and a greater vision to see these as two sides of the same coin rather than two separate budgets.
Unfortunately, I don’t see any of these as realistic due to the rush towards blind cost-cutting that we are seeing and worry that these kind of statements will have an increasingly negative impact on older people who are in hospital beds and who will be perceived as not ‘needing’ them as much as others – merely because as a society we haven’t been able to adequately meet their needs anywhere but hospital.
There’s a challenge for the government over the next year and while I’d like to start the new year on an optimistic strand, I can’t quite do it – but if I have one, smaller, more achievable aim, it will be to stop the use of ‘bed blockers’ as an acceptable phrase.