The term 'bed blocker' has yet again become commonplace in the media. It seems to be becoming a regular feature of discussion of the failings of the NHS. Yet what exactly is a 'bed blocker' and is it a symptom of a failing NHS?
A 'bed blocker' is shorthand for someone who is unable to leave hospital and return to their own home, even though they do not need medical treatment or care.
For many, the term 'bed blocker' is a derogatory term that fails to take account of the fact that it is a person who is being talked about, with their own personal circumstances, and not just a statistic. Use of the term does not take in account the myriad of factors that contribute to the person being unable to leave the hospital environment, usually through no fault of their own.
An alternative term might be delayed discharge. Although conveying the same information, this can be seen to be less value laden and less judgmental of the person involved than a 'bed blocker'.
The issue with a delayed discharge is that there are a finite number of beds available in a particular hospital. Some hospitals have reported that up to 10% of their beds are occupied by those unable to be discharged for non-medical reasons. This is often the reason that delayed discharge is in the news.
Having fewer beds available means that routine operations are cancelled because there is no bed available or that patients have to wait on trolleys in A & E for long periods while a bed can be found for them. This has resulted in some hospitals declaring emergency measures, which then becomes a news story.
Various studies have shown that the overwhelming majority of people who are unable to be discharged are older people and that there are many reasons why they cannot be discharged. Some will require additional care and/or treatment that is provided by their GP; or at outpatient clinic; or by nurses who visit them in their own homes and are waiting for this to be arranged.
For others, although they have recovered from the event that caused their admission to hospital, they need assistance with other aspects for their daily living and are unable to cope on their own, but appropriate services cannot be arranged for them.
Others may have rehabilitation needs or need to have convalescence care but it is not possible to find a suitable place for them. Some may need adaptation to their home to make it safe for them but the adaptations are yet to be undertaken.
There have even been reports of families refusing to allow their relatives to return home from hospital but rather insisting that they are found a place in a nursing or care home.
Delayed discharge of patients is not a new phenomenon or one that is unique to the United Kingdom. When I was nursing in the 1980s, there were often people on the wards who were not there for medical reasons but because no suitable place could be found for their convalescence or because they needed other forms of care such as those provided by social services and this could not be arranged.
Many countries with an ageing population have similar issues with their older people being unable to be discharged from hospital, even though they do not need medical care. However, as the proportion of the population classed as older people continues to rise, along with the increase in their non-medical care needs, so will the issue of delayed discharge.
In itself the delayed discharge of patients should not be seen as evidence that the NHS is failing. It is a problem and it is one that needs to be addressed. It is often the interface between the health service and social services that contributes to the issue and it is this that needs to be addressed. The lack of social care for older people, whether this relates to places in care homes or services that assist older people to live in their own homes, is a major contributing factor to delayed discharge.
Care for older people outside of the hospital needs to be reviewed so that, when a patient is medically fit to be discharged, the other services that are needed can be put into place for them.
A delayed discharge is not just a problem for the hospital who cannot admit another patient into that bed, it is also a problem for the person who is unable to leave hospital and return to their own life. Being in hospital is not fun, especially when you don't need to be there.