When my mum became a ‘bed blocker’, I saw the crisis in care for older people | Ros Coward

The case of Iris Sibley, trapped for six months in a Bristol hospital while her family and health authority hunted for a suitable care home, has highlighted how “bed blocking” is a key term in the crisis currently engulfing the NHS. When this week brought the news that nine out of 10 hospitals are overcrowded, NHS bosses pointed to major problems discharging patients. A&E’s failure to meet its four-hour target has similar causes and the excellent BBC TV series Hospital has highlighted how operations, both urgent and routine, are being delayed because beds needed for recovery are “blocked” by patients who no longer need to be in hospital.

Bed blocking is an impersonal term that expresses hospitals’ problems with resources. For the patients and family, it is much more personal. My mother became a “bed blocker” three years ago when, aged 89 and suffering from dementia, she collapsed and was admitted to hospital. She’d had several hospitalisations in the previous eight years but on the other occasions she’d been patched up and returned home. This time, after two weeks, she was declared stable but unable to cope any more on her own. I was told that a care home should be found, and rather sheepishly that the hospital “needed the bed back”.

We found a home within four weeks, yet it was another month before my mother was discharged

Like our society facing the coming crisis in elderly care, I wasn’t in any way prepared for this moment. Every time my mother had been hospitalised previously we’d seen first-hand what was being cited as the reason for much bed blocking: hospital weakened her, medication was altered, and her social care fell apart and became more difficult to re-establish as cuts hit social services. But in spite of all these mini-crises, we usually managed, eventually, to get her home. This time we had to make alternative arrangements.

The following five weeks were terrible. I was very distressed. I felt guilty. I had nightmares about making my mother leave her home. Contrary to Tory minister David Mowat’s recent comments that families aren’t prepared to care for their elderly parents at home, I clung to the hope that we could find a halfway house to rehabilitate her, or we could find additional social care to keep her at home. But the hospital kept pressuring and I shifted to scouring care homes and taking a crash course in what had become an overwhelmingly important issue: how a care home would be funded.

This was a lot of work, but ultimately it wasn’t me who held things up. We found a home within four weeks, yet it was another month before my mother was discharged. It is hard to pin down exactly why, but in the mix were cancelled meetings with consultants, staff absences and a lack of continuity between various agencies.

Worst of all was the finances. Endless time was spent researching funding and working on the care assessment form that determines the NHS’s contribution to care out of hospital. Despite huge numbers of older people now needing “medicalised” care of the sort previously provided in geriatric wards by the NHS, they are not entitled to full funding in care homes. But getting to the point of understanding entitlements and contributions and being therefore able to finalise the care home arrangements is a struggle. The eventual verdict had been anticipated by the discharge nurse five weeks previously: my mother was entitled to the basic further care element and the rest she would have to pay for herself, with the proceeds of selling her home.

Just as we began to gently prepare my mother for the move, she was abruptly shifted to another ward. She became extremely distressed and confused, and cried for the first time since entering hospital. And her whole care team disappeared – all the people with whom we’d been making these decisions and negotiating finances. The cause of this was again a shortage of beds, but for a person suffering from dementia and who was about to make the most important move of her life, it was awful.

It is not the fault of the NHS staff. In this instance they were uniformly compassionate. But while the staff don’t lack compassion, the system certainly does. Older people needing medicalised social care shouldn’t be pawns in a bureaucratic game where beds, forms and financial targets take precedence over humanity, while the NHS and councils, responsible for social care, desperately try to get the other to shoulder the costs. It’s shameful that resources are so scarce for the care of elderly people that it feels like horse trading to get anything at all.

Care for older people needs to change urgently. When my mother became a bed blocker the promises of the 2011 Dilnot report hung in the air. Dilnot was trying to rationalise the system, cap families’ contributions, and encourage social insurance to fund elderly care properly. Years later I’m shocked to find that nothing has changed. Theresa May talks about making Britain “work for all”, but Dilnot’s suggestions, which could improve life for elderly people and their families, have dropped off the radar.

When my mum became a ‘bed blocker’, I saw the crisis in care for older people | Ros Coward

Mind your language; they"re not "bed blockers" but older people

The NHS is faced with a rising tide of demand for care combined with a tight rein on both NHS and social care finances. The impact of these pressures is seen across the health and care system. It manifests itself obviously in delayed transfers out of hospitals.

Year on year these delays are rising, with more people staying in hospital when they don’t need to be there. It has an impact on the care of some of the frailest and most vulnerable people and is the subject of continued attention from the media, healthcare regulators and politicians.

When media and commentators discuss this issue it’s only a matter of time before a certain horrible term is used – “bed blocker”.

The phrase “blocked bed” originated in the UK in the late 50s, driven by hospital clinicians’ concerns about a lack of beds. Its use grew between 1961 and 1967, when the elderly population increased by 14% while bed numbers remained static. In 1986 “bed blocking” made its first appearance in a British Medical Journal headline. Although it was not accepted as a medical term, by the 90s it was being widely used by health economists as a marker of inefficiency.

The term persists to this day, despite many efforts to move away from it, such as the Department of Health’s redefinition of delayed discharge and delayed transfer in April 2001.

Surely the time has come to remember to whom bed blocking is referring. These “blockers” are often older people, who are frail and vulnerable and who would like nothing more than to return home to their families. The phrase “bed blocker” puts all the emphasis, and blame, on the individual. The reality is that it is the system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home.

Language matters. How we talk about people reflects how we treat them and, in the health service, how we engage them in the care they receive. When we stop talking about people as people and instead use the language of the system (units, targets, blockers) we risk undermining the compassionate care the health service was created for and has delivered for almost 70 years.

I rarely hear anyone who works in the health and care sector use this phrase. Those working with and caring for people see the individual. They know their individual stories and what matters to them.

There is a quiet revolution under way in the NHS. It’s increasingly recognised that people should no longer be seen as passive recipients of their care but as participants in both the decision making process and the care they experience.

This is the right thing to do and what people want. But it is also a response to people’s changing health needs. With more and more people managing long-term conditions, sometimes more than one at a time, the old “patch ‘em up, ship ‘em out” approach is a thing of the past. The health service needs to work with people to manage their own care, and this means understanding their individual circumstances, wants and needs. To do this well also means looking beyond the health service towards their family life and other institutions like local government, schools and community groups.

The NHS Confederation brought together experts from across health and care to form a commission on improving urgent care for older people. In Sheffield, new processes discharge many more patients home, to be assessed there rather than in a mock environment in the ward. A saving of more than 30,000 bed days was recorded there over the first year and people report better experiences of care.

North east London foundation trust and the London Ambulance Service have together provided a home-based emergency assessment and care package for people who fall, resulting in only one in 20 recipients being admitted to hospital within 48 hours. There are similar examples in Derbyshire, Oldham, Greater Manchester, Norfolk, Aintree and right across the country.

The NHS has a way to go in making sure these examples make up a default approach. But the term “bed blocking” is unhelpful and arguably one of the most inappropriate terms in the healthcare lexicon. Let’s consign it to the dustbin and focus on what we know works both for the individual and the health and care system.

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Mind your language; they"re not "bed blockers" but older people

Hospital individuals "should have a doctor"s identify over the bed"

Around 40% of hospitals in England already do this, but health officials want it rolled out across the board. Photograph: Christopher Furlong/Getty Images

Every single hospital patient must have a named doctor taking duty for their care, major medics have stated.

The so-referred to as “title over the bed” initiative will mean that sufferers, and their relatives and carers will know which medical professional is eventually accountable for all facets of their care, the Academy of Healthcare Royal Colleges (AMRC) has said.

The government mentioned it would introduce the measure as part of its response to the Mid Staffordshire NHS Foundation Trust public inquiry.

Probes into the scandal exposed that poor care could have led to the deaths of hundreds of patients as a consequence of maltreatment and neglect. Numerous were left lying in their personal urine and excrement for days, forced to drink water from vases or given the wrong medication.

New guidance from the AMRC says that every patient need to be supplied with the names of a accountable advisor and nurse throughout their keep.

It is understood that all around 40% of hospitals in England supply patients with this kind of information but health officials want to see the initiative rolled out across the board.

The Mid Staffs inquiry chair Robert Francis QC said that if a named clinician have been accountable all through a patient’s therapy in hospital then patient security and the all round quality of care could be improved, an AMRC spokesman explained.

As nicely as offering much more accountability to physicians the advice also says that a “named nurse” need to often be obtainable to be a primary stage of contact and offer patients with details about their care.

The Care High quality Commission will take into account no matter whether or not the measure has been implemented when they examine hospitals, a Department of Overall health spokeswoman stated.

Meanwhile the Common Medical Council (GMC) has issued new advice to help medical doctors in taking up the measure.

The AMRC was tasked to develop the manual by the overall health secretary, Jeremy Hunt.

“Individuals tell us that, as well frequently, their care is not joined up,” Mr Hunt stated.

“That is why every patient ought to have a single responsible clinician whose task it is to assist them with anything that goes incorrect and make positive they get the care they require.

“This advice will make that a actuality.”

Professor Terence Stephenson, chair of the Academy, additional: “Doctors recognise that we need to have to have clear lines of responsibility when it comes to the way individuals are handled during their stay in hospital.

“Some hospitals have currently implemented a ‘name more than the bed’ method and the place they have, patients say they have far more self-assurance that an individual is taking total accountability for them. They also know who to go to if they have questions or if they consider anything wants to be accomplished in a different way.

“This is vital if we are to drive up requirements of care and proceed to safeguard patient safety.”

Professor Sir Peter Rubin, chair of council at the GMC mentioned: “Becoming in hospital can be a worrying encounter for a lot of and this new part should offer reassurance to individuals and their households across England that there is a person overseeing their hospital journey.

“We want to do what we can to help doctors who are taking on this new part and this is why we have made a valuable guidebook which pulls collectively our current advice which we hope doctors will locate beneficial.”

Hospital individuals "should have a doctor"s identify over the bed"

Cancer-stricken medical doctor: hospital workers referred to as me "bed quantity seven"

Dr Kate Granger, who was diagnosed with a rare kind of incurable cancer at the age of 29, spoke of how she grew to become annoyed at being referred to as “bed number seven” or “the lady with the cancer” – and began a drive to adjust the way personnel deal with sufferers.

In 1 of the most stark circumstances, she told of how she was advised by a junior physician she had never met that her cancer had spread, without having any introduction, or checks to see if she desired a loved one by her side ahead of the devastating information was provided.

Dr Granger, 32, an elderly care doctor who writes a weblog about her experiences, informed a conference of NHS managers in Liverpool that the simple notion had now acquired 26 million net impressions, as nicely as getting backed by the Overall health Secretary.

She explained the campaign was not about “widespread courtesy” – but rather about recognising that vulnerable patients felt dehumanised by hospitals and necessary to be treated as individuals.

She stated: “Men and women kept referring to me as bed seven. It was even, ‘Bed seven, what would you like to drink?’”

“Going into hospital can be a very dehumanising expertise – you depart your persona at the door, you can lose your dignity.”

In the speech to the NHS Confederation’s yearly conference, she explained: “I feel this is much more than about frequent courtesy – this is about the human connection, developing a therapeutic partnership, developing trust and rapport. As a patient you can really feel you are at the bottom of the pile, in the power stakes and just an introduction can adjust things.”

Cancer-stricken medical doctor: hospital workers referred to as me "bed quantity seven"

NHS hospitals encounter record ranges of "bed blocking"

Hospitals are facing increasing “bed blocking” as they consider to deal with an boost in the quantity of patients needing to be admitted as emergencies this winter.

New NHS figures show the total quantity of bed days misplaced since of “delayed transfers of care” – generally induced because social care assistance is not offered to let a fit patient to return property – hit 70,124 final month, the highest December total because the NHS commenced recording the figures in 2010.

The 162,728 delayed discharges so far this winter are nicely up on final winter’s 135,368 equivalent.

Dame Barbara Hakin, deputy chief executive of NHS England, said it was “concerning” that the 103,071 sufferers admitted as emergencies final week was seven,781 higher than at the very same time the yr before and 1,259 up week-on-week.

While the number of cancelled operations fell week-on-week to 1,126, a total of 12,445 have currently been cancelled this winter, up one,220 on the 11,225 seen in the equivalent period twelve months ahead of.

Andrew Gwynne, the shadow wellness minister, said the figures have been “really sad and a direct end result of this government’s brutal cuts to social care”. He mentioned: “Ministers left folks with no the residence care they need and numerous flip to hospital for support. Hospitals are now complete to bursting and sufferers are suffering the unacceptable anguish of having their operation cancelled.”

NHS hospitals encounter record ranges of "bed blocking"

Jeremy Hunt: Doctors should quit thinking of individuals as "bed blockers and bodies"

Mr Hunt wants hospitals to move away from the “rigid shift patterns” imposed as a result of the European Operating Time Directive to guarantee that medical professionals have the “flexibility” to care for their patients.

In a speech at St Guy’s and St Thomas’s hospital in London, Mr Hunt will relate some of the letters of complaint he receives every day from individuals.

He will to say: “A single letter I received last March was from a lady whose husband sadly passed away right after what can only be described as two many years of chaotic care.

“Her husband was passed all around the program from clinician to clinician, with no a single appearing to know anything at all of his demands or historical past.

“One more letter I got this month came from a man diagnosed with cancer of the throat, but also a suspected secondary cancer of the kidney. His consultant referred to him inside of earshot not by his title but as ‘head and neck …#157′.”

Mr Hunt will contact for a significant alter in the culture of the NHS. He will say: “Every patient is a person. A man or woman with a title. A man or woman with a household. Not just a physique harbouring a pathology not a diagnostic puzzle not a four-hour target or an 18 week difficulty not a value pressure – and most surely not ‘bed-blocker … #157″.

He praised Dr Granger’s Twitter campaign to motivate doctors to be far more courteous when speaking to their patients. He will say: “Dr Kate Granger has highlighted the importance of treating patients as men and women.

“She has started out the campaign #hellomynameis, which has turn out to be increasingly properly-identified based mostly on the basic but essential courtesy of introducing oneself when meeting sufferers for the very first time. We can all learn from that strategy.”

Last year, Mr Hunt announced that sufferers will be offered a named medical professional and nurse who will be listed above their bed and be accountable for their care for the duration of every single shift.

He now wants to go additional and introduce “entire remain” doctors, who are responsible for a patient’s properly-becoming throughout their keep in hospital.

From right now, the Care Good quality Commission will make “continuity of care” a single of its essential “indicators” when carrying out assessments.

Mr Hunt will say: “This technique has confirmed extremely profitable in nations the place it is adopted. Lengthy stays and costs can be reduced. With wise flexibilities, the concept have to certainly be to ingrain continuity of care as one of our crucial priorities for each and each NHS patient. I want each hospital in the nation to adopt keep-at-residence physicians.”

Jeremy Hunt: Doctors should quit thinking of individuals as "bed blockers and bodies"