About This Blog

Welcome to James' Philosophical Agora - James' Meeting Place On-Line. (Updated September 2017)

This blog is the place where I write in a more personal way on various areas of philosophical interest. Please be careful when I say 'philosophical' because this does not often mean about purely academic or abstract subjects and ideas; but rather like much of the philosophy of Socrates, it means an investigation of some fundamental things that have a very important baring on the way we live our lives as individuals and as communities.

I have a separate blog where I share my enthusiasm for the specific philosophical tradition and ideas of Socrates, Plato, Aristotle Plutarch and others at: Socrates 4 Today However, this blog James' Philosophical Agora expresses mostly personal viewpoints and so I prefer to have two separate blogs.

Please feel free to comment on any of the blog posts, or add some thoughts of your own to the subjects discussed. You can also contact me personally if you would like to discuss any particular items further at: jamesdelphi2000@gmail.com

Sunday, June 11, 2017

Bed Blocking in NHS and time to broaden the brief of the NHS

Time to Rebrand the NHS for the next century

Bed blocking by elderly patients in National Health Service wards is just one illustration that it is now time to ditch the NHS in favour of the 'National Health and Well-Being Service'  (NHSWB ?)  This new service should incorporate elderly onward (transitional and on-going) elderly care within its planning and budgeting, and indeed look at the Health and Well Being of the nation as a whole. This new role for the re-branded NHS could truly support people from ‘cradle to the grave’ and could move away from being the place you go when you are sick; and leave either when you are better, or staff feel they can no longer improve your physical health with treatment.

Such a bold move as outlined above while sounding expensive and untenable might on investigation prove not to need as much extra funding as one might first expect. The rational for this is briefly outlined below.

A re-branded NHS that had responsibility to provide better social care for the elderly, would at the same time be able to free up many hospital beds that had been previously blocked by elderly patients following hospital clinical treatment – for minor as well as more major issues. In addition, a slightly different ethos to health by the government; that is, a greater emphasis on prevention and well-being after treatment to avoid re-admittance, would be preferable for many reasons than simply providing treatment after people get sick or have accidents.

The fact remains that for all users of the NHS both young and old, once someone has actually been admitted to hospital bed the treatment one receives in hospital ward is generally very good. The problem for most people is to get admitted in the first place and not turned away from A & E or have an unreasonable time to wait on the dreaded ‘waiting lists’ if referred by the GP. 

For example, after several visits to A & E with my elderly mother (requiring an ambulance to be called each time, and A & E staff time to be taken up) she was finally admitted to a hospital bed and received the treatment she needed. Another quick example worth mentioning is the elderly mother of a friend of mine who following her hospital treatment would need social care for when she left hospital.  An appointment with the social care staff was arranged three days after her clinical treatment finished. The social care member of staff went to the wrong hospital for the appointment and so another appointment was arranged a couple of days after that.  This meant that the elderly lady had taken up a hospital clinical bed for a minimum of five nights before even receiving any first consultation with social care staff about what would happen to her next when she left hospital.  This is not a big deal in itself were it an isolated example, but I suspect this kind of waste of valuable clinical bed nights in hospital wards is prevalent throughout the NHS, and possibly no real fault of their own making, since they are relying on the local government social services department in order to progress the matter and clear the bed for the next patient.

There is nothing particularly difficult about arranging onward social care for these elderly clients.  It is not rocket science, particularly for a service like the NHS that can arrange complex operations and aftercare for tens of thousands of clinical patients each month. Why then do they need to be slowed down by different social services departments across the country to free up the beds.

The only problem about the current NHS arranging social care for the elderly (and onward placements for clinical patients) is that it is not in the brief of the NHS, and not part of its planning and budgeting for the years ahead to provide this kind of provision and service.

There is no need to outsource this social care provision (particularly for patients who have finished their clinical treatments in hospital) to expensive private care providers, or large cumbersome often parallel government social services departments with their own cumbersome staffing arrangements, office administration's, and priorities on their budgets and resources.  For the NHS, surely being able to clear 5 - 10,000 (?) hospital beds each night across the country would be much higher up their priority list, since it would allow in a single stroke the NHS to meet many of its other targets and goals much more easily.  Whereas care for the elderly leaving hospital is much further down the list of priorities for social services departments with many other calls on their limited resources.

It seems to me therefore, that the NHS is ideally placed, ideally staffed at management and ‘hands on’ level, ideally resourced and already set up to easily factor in to its planning and budgeting this simple provision of onward social care for elderly clients who are blocking valuable clinical beds.

I strongly suspect that a similar situation prevails in residential mental health provision, especially for younger people where clinical beds on psychiatric wards are very scarce indeed. Are these valuable bed places also being blocked once clinical care has come to an end because the onward journey of the patient is delayed several days at least owing to social services departments acting slowly and without any sense of urgency or priority to quickly facilitate the appropriate aftercare for the mental health patient?

It is time to do away with the NHS as soon as possible and welcome the creation of the National Health and Well Being Service, which will have a broader range of responsibilities including onward social care for all patients leaving clinical hospitals. In addition, it should give a new and greater emphasis on prevention and wellbeing within the nation as a whole, rather than the 'let's wait until you get sick - and then fix you up' approach that we seem to be adopting at the moment. This latter approach that we are currently adopting may well come at greater (not less) expense, with greater disruption to lives, and greater other inconveniences to all concerned.