Sent to Secretary of State for Health
Bed blocking is a very familiar phrase. It seems to have been a problem within hospitals for years, Indeed we understand that measures have been in place since 2003 to try and reduce it, but without success, and according to our research it has increased by nearly half in the last five years alone equating to around 5000 beds blocked every day.
Bed blocking by patients with ongoing needs has two significant effects. One is general with the lack of beds leading to increased pressures in A&E departments, more trolley waits, cancelled operations and so on. The other effect is on the patients themselves, particularly in older people. Ironically longer stays in hospital can lead to worse health outcomes and increase long-term care needs. Older people can quickly lose mobility and the ability to do everyday tasks such as bathing and dressing. Even short stays in hospital can add to significant muscle wastage.
The NHS and Local Authorities providing social care are both, we understand, responsible for these delays leading to bed blocking. Yet despite legislation imposing detailed monitoring, statutory duties and financial penalties on the both the NHS and Local Authorities, bed blocking continues at an unacceptably high rate.
The problem as we see it is caused by a mixture of chronic underfunding and a significant increase in numbers of older people. It is no surprise that 85% of all bed blocking concerns people aged 65 or older, costing a reported £820 million a year, which is the equivalent of 2.7 million days of bed blocking in a year. Local Authorities in charge of social care are partly to blame but they have suffered huge cuts to their budgets with social care spending in England shrinking by £7bn. This coupled with an increasing numbers of older people and rising care costs mean adult social care services already have a £1.5bn funding gap for this year, and that will only rise in the future if steps are not taken.
The solution to bed blocking known as Intermediate Care is not a new idea, having been around for over 30 years, and indeed it has been championed by NICE in the last decade as best practice.
Intermediate care services are provided to all patients, but more usually older people aged over 80, after leaving hospital or if they are at risk of being sent to hospital. The services offer a link between hospitals and where people normally live and between different areas of the health and social care systems.
There are three main aims 1) to help people avoid going into hospital unnecessarily; 2) to help people to be as independent as possible after a stay in hospital; and 3) to prevent people from moving into a residential home until they really need it. The care can be provided in different places for example, a community hospital, a residential home or in a person’s own home. Care is given by a variety of different professionals from nurses to therapists to social workers and is tailored to the individual’s care plan.
It’s a very flexible system and care lasts no longer than six weeks. People can be sent to a bed-based unit straight from home without needing to go into hospital at all. It is clear that intermediate care is crucial for ensuring that older people with complex needs are seen by the right service at the right time, so ending this bed-blocking gridlock and ensuring that life-changing decisions aren’t made prematurely about long-term care needs. It is a sad fact that a person going into a care home straight from hospital, even on a temporary basis, is far less likely toreturn to live at home ever again.
National audits of intermediate care nearly every year since 2012 all show that it is very, very effective with the vast majority of patients maintaining or improving their levels of independent living. However to ensure these services are available to all who need it, and to reduce the amount of bed blocking occurring in hospitals, much more investment is needed. Over the last 10 years we understand that beds have been closed in nearly a third of England’s 340 community hospitals, so there are now fewer beds available than ever for this intermediate care at a time of greater demand.
What we desperately need is more funding for bed-based intermediate care units, and also for the Local Authorities to allow them to fulfill their equally vital role in social care working with the NHS to provide a fully integrated intermediate care system.
The reported evidence for the benefit of bed-based care units is overwhelming. Patients have much better outcomes, acute hospital beds are freed up, and in the long run it makes considerable savings for both the NHS and Social Care providers. However provision at present is nowhere near adequate, many areas do not have these units in place, and it is a postcode lottery whether older patients have access to such rehabilitative care or not.
Therefore we urge the Government as matter of greatest priority, to provide sufficient funding to the NHS and Local Authorities to provide a uniform and comprehensive bed based intermediate care service for all throughout the country.