Unblocking the NHS

‘Hosts would be asked to welcome patients recovering minor procedures, cook three microwave meals a day and offer conversation, according to CareRooms, in a scheme targeting people who do not have a family able to care for them.’

 

If the NHS is a body under assault from our rapidly expanding and ageing nation, then so-called ‘bedblocking’ is a fatal clot in already narrowed arteries. Up 40% since 2016 and 172% since 2010, some 70,000 patients were delayed discharge last year awaiting social care packages for their homes; 6,000 patients – by very conservative estimate – are currently stuck in critical care beds awaiting release, contributing to an estimated 8,000 deaths a year and some £8m in wasted funds as patients in need are denied beds and elective surgeries are cancelled. This January, the NHS took the unprecedented step of cancelling highly urgent and protected cancer surgeries.

 

The NHS may top the annual Commonwealth Health Fund ranking in 4 of 5 categories, but it ranks 10th on outcomes – meaning that for all its efficiency and access, the results of its care (particularly for sufferers of strokes, breast or bowel cancer) put us just above the much-reviled US system. As Alzheimer’s takes the lead as Britain’s top killer, our desperate lack of social care infrastructure will only push us further down this list, with devastating consequences for every patient dependent on the NHS’s fragile eco-system of care.

 

So what is being done? In the midst of many complex causes – most critically, the systemic lack of joined-up thinking at the highest levels that places the delivery of fragmented budgets and short-term agendas above connection to the increasingly desperate big picture – resolving bed blocking is a clear priority with enormous quick wins.

 

Nottinghamshire county hospital has been beating blocks using Nervecentre software to identify patient pinch-points in real-time, and social care ‘cluster’ teams who work closely with medical staff to assess need well ahead of release and move fast to provide interim care packages – costing some £50 a day instead of the £300-a-day hospital bed –  ensuring smooth releases are achieved even in times of heavy traffic.

 

Other voices, like Dr Brian Campbell writing in The Spectator, propose the urgent opening of ‘low dependency hostels’ to free up beds.

 

But perhaps most interesting of all is Care Homes:  the air b’n’b solution to ‘care in the community’ which offers recuperating patients a private room and hosts up to £1k a month. Developed through the enterprising  Clinical Entrepreneur programme, the programme promises both to ease bedblocking and strengthen our desperately under-resourced social care infrastructure.

 

Warnings about quality safeguarding should be heeded and addressed – but the entrepreneurial spirit and systems-thinking approach of this trial is exactly what our NHS needs to get unblocked.