bed blocker

    A ‘bed blocking’ crisis threatens the NHS. Here’s how to fix it

    7 February 2017

    The NHS is the victim of its own success. Every patient whose life it saves and patches up is a guaranteed re-attender. Currently, acute hospitals throughout the land are being prevented from performing their vital functions because their beds are filled by almost well people who are not quite able to return to their own homes. This may be because they have mobility needs, or are unable to fully self care, or sadly they may lack somebody to look after them.

    These poor souls have rather rudely been awarded the sobriquet ‘bed blockers’.

    As a consequence of this log-jamming, extremely unwell, unconscious, breathless and septic newly arriving patients are having to wait in ambulances because there simply is no room at the inn. Elective surgery is being cancelled for the same reason. The tremendous waste of resources and the expense of providing fully staffed hospitals that cannot admit patients is as mind-boggling as it is depressing.

    Care in the community was suggested as a solution to the bed-blocking problem, but in reality it is an expensive fantasy. Where I live, it takes all night for two nurses to travel from one end of the county to the other, twice. Geography matters! In cities with hospitals at every corner and short distances involved, then maybe, just maybe, it can work.

    Staff matter, too. If you make a health service career too academically challenging, you will persuade the more caring but less book-talented people to look elsewhere for work. The best nurses I have ever worked with all possessed tremendous humble ordinary sense and they also lacked any spirit of egotistic entitlement. They just loved to nurse.

    Every nursing student nowadays must attain a degree qualification and be continuously appraised. I witness many worthy lasses and lads who work as healthcare assistants and domestics being turned away from nursing because they lack mere qualifications while excelling in caring human qualities, great presence of mind and naturally high esprit de corps.

    The cure for the NHS is not simply to close beds in the hope of saving some dosh. It is to open low dependency hostels, where those nearly well ‘bed blockers’ can be housed while they await their return to their homes. This will free up acute hospital beds for the care of the acutely unwell, allow for elective surgery to resume, and provide for the optimal 85 to 90 per cent occupancy of acute beds which is necessary for safe surge management and for hygiene and infection control to be implemented.

    The government should act urgently to provide these hostels. If the Jehovah’s Witnesses and McDonald’s Corporation can erect premises in a day, then perhaps Her Majesty’s Government has a chance of doing similarly in less than a decade.

    Green-field, single storey, low dependency hostels are needed, with lots of parking for visitors and staff. Minimal medical cover could be provided by GPs. Physios, occupational therapists and social workers would do the bulk of the rehabilitation needed for the patients to get home. Basic care would be provided by health care assistants and the domestic staff, while needing little senior nursing supervision.

    Why not provide some palliative care beds within the new build too? It is scandalous that terminally ill people are languishing in noisy acute wards with limited visitation by their kin. Move them out to the poppy field-hospital, and improve the quality of their dying.

    If you think I am reinventing the wheel, then I confess I am a bit. All of the above was provided by ‘cottage hospitals’ until some well meaning, cost-cutting brainiacs decided to close them all and provide care in the community instead. This might have seemed like a nice idea, but the logistics never adequately materialised as it relied on local government supplying their end of the bargain, and they couldn’t.

    The NHS has to meet the tsunami of unwell people coming into it in a humane manner. That is, without euthanasia, or rationing. To do this, it needs to realistically manage the ‘bed blockers’ within itself.

    Quite honestly, when you and I become a bit helpless in our declining years, we won’t be asking for high tech medical miracles to be performed upon us, but only, appetite permitting, to be fed at the top end, and wiped clean at the other, and to be got home ASAP. Who needs a carer with a university degree to provide such basic needs? This kind of looking after is basic humanity learned during child rearing. I live in hopeful expectation that such a staple will still exist in a few years when you and I might need it.

    Health service policy isn’t rocket science, or even brain surgery. It is simply giving a damn about the sick, who are with us always, even to the end of time.