Bed blockers?

I wanted to say more about bed blocking because it is the tabloid headline phrase, the shorthand used to conjure images of elderly people waiting for places in nursing homes.  But it’s a lazy stereotype, and it’s one of the means whereby the concept of value in public services can be so easily reduced to one of finance and ‘efficiency’, and the so-called ‘difficult choices’ in cutting funding to the point where they collapse.

There are many reasons why someone might be in a bed which is needed for someone else. By definition it is almost always the case that such a person is also not having their needs met in an acute setting, because so many of those needs are pastoral rather than treatment-based. Their best interests might be to take them home with support; to take them to residential or nursing care; to begin specialist rehabilitation; to access specialist care and treatment centre for those with a particular acquired condition; or perhaps a hospice or other end of life care. None of those decisions will be straightforward, all will involve a multi-disciplinary team of professionals to assess and coordinate what’s in the best interests of the individual.

These are not decisions to be rushed. Where it’s clear cut, there should be the provision in the social care system to action the decision of course, and that’s largely missing. The halfway houses (community hospital wards being one vital resource that’s been decimated) are at best overstretched. In the meantime, a purgatory exists between the two systems of acute medical services with the potential for a level of recovery, and the decision to move to palliative care.

Imagine the complexity, the medical ethics, the emotions, the fading hope. I want to say that today, because I fear I’m guilty of a lack of sensitivity towards the many human beings, families and friends in that position. I’ve chosen freely to publicise my own thoughts and worries and to highlight the wider political implications, to have a mission. But how easy it is to casually trample yet another diverse and vulnerable group of individuals into the mud of a tabloid headline. These individuals are equally deserving of proper, well-resourced and funded care, and very often they are not getting it. They are also deserving of the time they need to negotiate the inherent web of emotion and conflict.

Action

On 11 March there will be an attempt led by Caroline Lucas MP, with support from a cross-party group of MPs to introduce the NHS Reinstatement Bill.

I’ve given the link to 38Degrees‘ page which has a further link for your MP’s contact details. There is also a link explaining what the bill aims to do.

If you’d like to do something proactive, might I ask you to contact your MP and ask her or him to support the bill?

You might also ask questions about cancelled operations in your area, and about cuts to social care and community and general hospital beds.

My MP has yet to respond to my points, perhaps because he is too busy earning his £460,000 annual salary as a barrister. But maybe yours will.

Thank you.

 

 

 

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No Beds

1262504_10151822703488251_1557854932_oThe op date will be confirmed today and I might have 2 more days, or not. All action at home; we’ve moved the room around and there’s a desk space which was a key job to finish.

Honey aka Bun, has been behaving oddly, asking to go out at 1.30am and vanishing for ¾ an hour then lying on the frosty grass. While dogs are acutely sensitive to vibes, she is otherwise secure, has stayed here often since I got her, gets fed sausage and other delicacies (I once arrived to collect her after a run of shifts to hear Mum exclaiming: “Damn! I’ve overcooked Honey’s asparagus!”)  I’m concerned there’s something else going on. We go to the Vet’s and have her anal glands checked, finding that they are indeed full. That’s a relief for her and me.

Wandering up the footpath with my walking pole for security (I negotiated with Mum that I could go out alone provided she knows where I am and I have my phone) I feel horribly weak. I have a fine, internal tremor, one that I’m unsure is physiological. Sub-butterflies perhaps, combined with the general knock off in strength that I’ve been struggling with for several weeks. I ring Kari and as ever we end up laughing and she suggests we go off on a trip to Budapest’s thermal baths, and also Rekjyavik. Maybe in a couple of weeks? I tell her about chatting to my friend yesterday, discussing menopause symptoms. C had listed hers:

“And I think… is there something wrong? No, it’s just the menopause”.

“Or it might be a brain tumour.” I reply and we end up guffawing.

Taking the advice of my Macmillan supporter, I have accepted practical offers of help, and so a friend who’s an IT bod came with his partner and dogs for lunch, bringing fabulous cakes from Exeter including one called Ginger Dick. So voice recognition is now set up on the netbook, and I have extra memory on order to speed up the operation which M will put in next week sometime. We look at transferring all my Mac files from the Macbook, and I list all my passwords and email addresses attached to accounts in a notebook. Another massive relief. It’s as ever, lovely to chat about my stuff and gain another perspective, and also to talk of their lives and our dogs and swimming expeditions.

No call from neurosurgery, so I rang at 4 and was put through to Mr Fewings’ secretary who tells me she will call as soon as she knows, but that there are no beds.  They’re in a meeting now, trying to discharge some people, and there are six of us on the list this week to find beds for (along with emergencies, of course).

The NHS has been dropping beds since 2010 and the start of austerity. We have among the lowest number of beds per head in the developed world. By beds, I mean not just a bed, but also the staff and equipment to man it. This is related to cost, and it’s of course considered inefficient to ever have an unoccupied bed. But a hospital is not a Premier Inn; for the system to operate properly there must be resilience, some flex in the system, so that in addition to the unpredictability of acute illnesses and admissions, there is also the ability to contain people who cannot be discharged when expected.

This latter point is a huge one. Bed blocking is the result of massive cuts to social care budgets since 2010. The extra strain on the NHS makes a mockery of all those claims of ring-fenced budgets which are in any case misleading because there is no contingency for increased usage nor for inflation – Southwestern Ambulance Service’s usage rises 7% annually, and has done for years.

The average loss (devolved to councils so that the government can lay the blame with their budgeting rather than the 35% central cuts to local services) from social care budgets is between 30-35% since the coalition took over in 2010. Incidentally, Tory run councils including my own are receiving bail outs from government to protect some key services, while Labour run councils are not.

If there is no safety net when a vulnerable person (frail elderly being the most likely group to be in this situation) is discharged, then they can’t go home. Elderly people usually do not need to be treated as medical emergencies and it’s not in their interests either. I’ve taken many elderly people back in to hospital in the 24 hours after discharge, because they can’t cope. Local, community hospital beds play a huge role here, because they provide a place of safety where assessment and treatment can take place, in a location where friends and family can easily visit. These people need to be supported, to have their conditions managed, to be loved, not dashed through a system that’s there to try to cure them; there’s no cure for old age.

Community hospital beds are like gold dust, and ambulances are routinely forced take elderly, frail patients (“off legs” is the generic term used, meaning anything from a urine infection, to constipation, to heart failure) into the acute hospital which in this area might be 50 miles away. Often they’re confused, and on an inappropriate ward (surgical, oncology) where they become distressed and wander around. I once arrived on the AMU in the Royal Devon and Exeter to find a bank nurse specially employed for the task walking up and down the bays with a demented elderly woman who was wailing, and screaming that her husband had been killed. The other patients were clearly unwell and upset, as was this poor woman who had been sent in due to “increased confusion” from a residential care home, which clearly could not manage her.

In my area, Moretonhampstead wards were closed not long ago, on the basis that the Okehampton community hospital was ‘underused’. It most certainly would not have been underused had those beds been open – but they wer closed to save money. We could have filled them twice over, but instead all those people were being carted off to Exeter by an ambulance (25 miles rather than a local trip) which is then not available for 999 calls for well over an hour. And Exeter fills up, starts to breach the 4 hour ED targets, blocks at the AMU. Add to that the resultant travel concerns for elderly relatives who have to hike 16 miles by bus to visit patients who might well be end of life.

The justification for closing beds is always some combination of underuse/efficiency and the provision of social care in the community. The latter is often – but not always – a grand idea but it costs a lot of money to set up and run properly, and also requires huge support for carers. Imagine too living with a hospital bed in your sitting room, hoists along the ceiling through the doors to the bathroom.  It’s an ideal, but the impetus is key. Currently care in own homes is used to justify cost-cutting closures, when it’s anything but the cheaper option. The costs are moved elsewhere  (GP, ambulance service, emergency departments, acute medical units). And at the end of the line is someone like me, awaiting urgent surgery, but without a bed. Planned surgery will of course have already been cancelled. This is anything but efficient. It’s a massive waste of costly theatre time and all those massively expert staff who are now waiting around rather than doing their jobs.

So here I am in the wee hours, with no idea whether my op will go ahead this week at all.

Last eve my brother Iggy, sister in law Sarah and nephews Lee and Max arrived along with Lee’s gorgeous partner Louise. It was lovely to see them, though it felt rather like the last supper (with salty snacks rather than supper). I showed them my text from the DWP. Their faces said it all.

Reading over this post it sounds flat, and reflects I think a slight separation I feel from my soul. I’m off to Bantham today because I’ve been doing a job for the Outdoor Swimming Society helping to set up for an advert involving wild swimmers. I’m really going along for the craic, because I’m not up to a whole lot physically or emotionally, but I’m so looking forward to spending a day with the production crew and my friends. I guess in my head I’m floating down the Aune Swoosh, one of our favourite swims, and ahead of me is the estuary rip and the reefs and breakers of Burgh and Bantham. But I’m seeing and feeling it from the drone that filmed this swim last year, swooping overhead and in and out of different parts of the action, unable to quite hear the water, taste the salt or see the fish.

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