A report in the media last weekend highlighted claims of NHS leaders that bed blocking in hospitals is hampering the efforts to combat the emergency care crisis.
The situation is critical with more than 13,500 beds occupied by patients who have been declared fit for discharge. This is triple the pre pandemic average.
Impact of bed blocking
People who remain in hospital longer than is necessary run the risk of sickness through infection, delirium and muscle wastage. They are also being deprived of their independence and choice of where they wish to live.
Bed blocking is contributing to fatal ambulance service delays. As we have all seen the familiar sight of rows of ambulances stood for hours outside A&E Departments waiting for a free bed. Meanwhile they are unable to respond to real emergencies and the outcome may lead to needless deaths.
It is estimated that every month, more than a hundred thousand people are forced to wait outside casualty departments for up to 12 hours because there are no beds available to them.
How have we arrived at this situation?
The NHS has arrived at the current situation because they are unable to transfer people from hospital into care homes or to their own homes with appropriate support. This trend has been going on for years and is the result of under investment by the government in social care.
The government solution to increase national insurance and allocate the money to the NHS and social care is a sop to placate the social care industry. They will not receive any of the allocation until the NHS has cleared its backlog of emergencies and waiting lists are cleared. This is expected to take several years.
What can be done to alleviate the situation?
Firstly, the government needs to take urgent action, and put ringfenced real investment into social care. It needs to recognise that the NHS and social care are independent of one another, and an effective fit for purpose NHS will never be achieved without the contribution of social care. We should be pursuing a dual paradigm that of a hospitals central role seen as treatment for patients, with care and rehabilitation provided by social care in the community.
To achieve this, we need to recognise the valuable contribution made by social care workers and reverse the exodus of care workers to the retail sector. This will not happen unless care workers are able to earn more than they could stacking shelves in supermarkets. Providers need to be supported to pay staff wages commensurate with the responsibility and skills required to do the job.
Nor is it just a question of higher wages. This may help to recruit staff, but what is needed is the means of how we will retain them. We need to do more providing workers with better employment conditions, staff training and a career structure linked to renumeration.
Ruth Isden of age UK says “care providers could double the number of people they could offer services to, if only they could recruit more staff”.
The government has dragged its feet in confronting the problem of bed blocking and now faces a crises situation in the NHS. It has failed to provide the required investment in social care, and any benefit that the care sector may have gained because of the national insurance levy, will surely be swallowed up by the demands of the NHS.
To alleviate the problem the government needs to provide as a matter of urgency, ring fenced funding for social care.
If carers are going to be recruited and retained, they must be given the professional recognition they deserve with appropriate levels of pay and working conditions. In addition, staff must be trained to meet the demands of the job along with a salary structure that rewards long serving staff.
Only then might we see an improvement in the reduction of bed blocking, and an end to the scandal of forcing people to remain on hospital wards against their will.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy