It’s going to get worse and worse… Bed-blocking may mean you don’t get treated when you need a hospital yourself.

Chris Smyth in the Times 9th September reports: Winter alert as bed-blocking hits record

Bed-blocking is at a record high as NHS decline continues, official figures show.

Hospitals predicted a “winter of discontent” as they struggled to cope even in summer, warning patients to get used to long delays.

More than 200,000 patients waited in excess of four hours in A&E in July and the target to see 95 per cent within this time has not been met for a year.

Cliff Mann, president of the Royal College of Emergency Medicine, said: “The system is in crisis — the pressures departments experience in winter are being felt almost all year round.”

Health chiefs said that junior doctors’ strikes planned for the autumn posed “obvious risks to patients”. Targets are also being missed for emergency ambulance call-outs, routine operations, diagnostic tests and cancer treatment.

Siva Anandaciva of NHS Providers, which represents hospitals, said: “We are becoming increasingly worried about this continuing deterioration in performance. The summer is usually a quieter time. We are heading towards a winter of discontent, with this relentless cycle of record high A&E attendances, increasing emergency admissions and greater numbers of patients who cannot be discharged because the services they need in the community are not being properly resourced.”

Patients were stuck in hospital when fit to go home for a record 184,188 days in July, a bed-blocking rate 25 per cent higher than last year. On a sample day 6,364 patients fit to leave were still in hospital, the highest number on record and up almost 50 per cent on last year.

Vicky McDermott, chairwoman of the Care and Support Alliance of charities, said: “More people are being kept in hospital unnecessarily because of failures in the health and social care system.” She blamed cuts to council social care services.

Nigel Edwards, chief executive of the Nuffield Trust health think-tank, said: “There’s a general feeling that we’re managing gradual decline and the question is when do we get to breaking point?”

Julie Mellor, the NHS ombudsman, said: “Health and social care leaders must look at the discharge process as a whole and uncover why ten years of guidance to prevent unsafe discharge is not being followed.”

Targets to carry out routine operations such as hip replacements within 18 weeks are also being missed, with 3.7 million people now on an NHS waiting list.

Matthew Swindells, director of operations at NHS England, said: “As the NHS responds to increasing care needs, hospitals are continuing to look after more than nine out of ten A&E patients within four hours, and more than nine in ten patients are waiting less than 18 weeks for routine operations.”

Aug 13th letters: Solving the NHS bed blocking crisis together

Sir, In November 2013, concerned about bed blocking, I wrote to Jeremy Hunt and David Cameron to offer the aid of our country’s voluntary sector in ensuring that elderly people are supported in the community and not in hospital beds when there is no need for medical interventions (“NHS crisis deepens as bed blocking costs £6bn”, Aug 12).

The work of charities such as the Red Cross and Royal Voluntary Service, working in casualty and on wards helping safe patient discharge, has already been highly effective and could be rolled out to every hospital. Other than a small intervention in 29 hospitals funded by the Cabinet Office, this offer has been spurned by government and the NHS. It is time for a national initiative that galvanises our charities to help out in this crisis.

Sir Stephen Bubb
Director of Charity Futures

Sir, For too long funding for social care has been cut and cut again. A funding gap running to £30bn is predicted for our health service by the end of the decade and for social care that gap is at least £4.3bn, yet within eight years one in five of us will be over 65.

Health and social care are not separate entities. If one area is not functioning, it will impact on the other. The long-term solution is to create a collaborative model where local authorities, the NHS and voluntary agencies work together to put people at the centre of their own care. In the short term, however, there is funding allocated for social care support. The government has set aside extra money to enhance the Better Care Fund, but most of that is being held back until the end of the decade. This money could be helping thousands, including some of the 6,000 people trapped in hospitals across England right now. We urge the government to release this funding.

Colin Brown
Director for independent living and crisis response, British Red Cross UK

Sir, What happened to convalescent homes? I remember my grandmother being in one for about six weeks while she recovered from an orthopaedic operation. There were fewer old people and less that medical science could offer then, but the convalescent facilities provided a more homely atmosphere in which to recover and gave patients some breathing space.

Jennifer Rees
Cardiff

Sir, As many as a third of patients do not need to be in NHS beds, and while the significance of joined-up working with social services and community care is important, it is not the whole story. The housing shortage for young starters is but one end of a problem. The other end is the need to ensure an abundant supply and range of housing options for older people and to redesign neighbourhoods to provide supportive environments.

If we get this right, together with good community health and social services, a large proportion of admissions could be avoided and patients who are admitted could be discharged sooner. A good start would be to have a housing sector board member on each NHS trust.

Dr John R Ashton
President of the UK Faculty of Public Health 2013-16

Sir, The current NHS financial challenge has left commissioners, providers and clinicians facing increasingly tough decisions about patient care as they try to prioritise funding and balance their budgets (“NHS cuts threaten hospital closure”, Aug 11).

The scale of savings required cannot be generated by productivity improvements alone and it is inevitable that some organisations will be forced to restrict access to services or dilute the quality of care they provide because of the financial imperative. Politicians need to be honest with the public about what the health service can offer with the funding made available to it.

Chris Ham
Chief executive, The King’s Fund

May 26th: Bed-blocking costs NHS £820m a year

 

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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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