When I moved to Oxford in November last year, it was disappointing to see that the nursing in the big local hospital was no kinder or more attentive than in London. Nursing assistants recruited from agencies still seemed to be doing most of the hands on work. But at least there is a plan in place to tackle the problem of ‘bed-blocking.’
This lethal NHS grid-lock is caused by too many people needing too few beds, and older patients being unable to leave hospital safely. This almost 5,000 patients ended up stuck in hospital needlessly. Before we have even got into winter, official figures show that last month more than 143,000 hospital days were taken by patients who should have been sent home, or to care homes, a 22 per cent rise in just two years, from 116,881 in October 2012.
In this county there is a ‘community hospital’ based on the site of a larger hospital. There are now 300 of these in the UK. Community beds are used for intermediate care, for people who have just left hospital but are too frail to return home, releasing acute hospital beds. They are hardly cheaper for the NHS, about £650 – £400 a night but they take the pressure off acute care beds, and offer patients a release from the typical British hospital with its noise, bright light and terrible food.
I felt optimistic when I visited one for the first time last week, in my role as a voluntary hospital visitor. It looked like a good old people’s home, sunny and cheerful, except that the first two women I met were only in their late 40s. Many bed-blockers are alone in the world or their lives have been rendered down to just one dependent spouse waiting for them to come back home.
They nearly all experience great agony of mind about dependents, and these younger people, both in wheel-chairs, were exactly the same. They had been in the unit for over a month, waiting for their ‘care packages’ to be put in place by social services so they could get home. The first woman had a husband with early-onset dementia. ‘He doesn’t talk to me, he doesn’t visit,’ she said, working her way through pages of cross-word puzzles. ‘He only knows me now and then and while I am in here I have no idea what he is up to.’ Since he became ill, she said, he’d started spending their money like water, without telling her. She’d taken out a separate bank account and gave him an allowance but he usually ran through it within a few days. Since she’d been in hospital and then the unit he’d begun replying to adverts for big cash prize competitions, and had double-glazed patio doors fixed costing over a thousand pounds, although she said they didn’t need them. She and her sister had tried to control his spending she said, but they had very little chance as he had all the rights of an independent adult. ‘My mother left me some money,’ she said, ‘but it is all slipping away. From here I can do nothing about it.’
The other woman staring out of the window despondently, was equally anxious as she had a teenage daughter at home alone. She worried about her all the time. The unit looked nice but I felt it contained people as desperate as political prisoners. Both were troubled by being in a unit with mainly much older people, including a woman with dementia who kept everyone awake at night. They were frustrated by knowing that they could go home tomorrow if social services found enough time and resources to set up their social-care packages.
Some put this crisis down to a lack of NHS staff available to discharge patients. There is increasingly too high a bed occupancy, amid increasing numbers being admitted to hospital after arriving at Accident & Emergency. But it is the basic lack of social care provision that is the problem, not the hospitals or special units. The lack of social care to help patients go home is fuelling this crisis. According to figures published recently, Local authorities lost forty percent of their total funding in George Osborne’s first term as chancellor and his summer budget will take another 40% by 2020. That is a huge bite out of services already gnawed to the bone.
The Local Government Association which represents all the councils in England, and is more Tory than Labour, this week sent its submission to the Treasury, warning that councils already have a £10 billion size hole in their finances and can’t cope with more cuts. Community hospitals and small rehab units are now also losing their beds. I came away from my first visit to what could have been a compassionate solution to the NHS gridlock, chilled by the level of desperation in some of the women I’d seen; not old, sad or deranged, but with lives still to lead. I asked a nursing sister about the likely provision of care-packages for them and how soon would they get it? ‘There is no social care out there,’ she replied angrily. ‘It no longer exists.’ return