Op-Ed: Bed blocking is making British headline news again but what lies behind that derogatory term?
Where to start?
If you are an NHS hospital patient classed as medically fit but not able to return home you may be called a bed-blocker. It could be that you need adaptations to your home prior discharge or that you need a place in a care home, either temporarily or permanently, but whatever the reason your status as patient changes to bed-blocker.
With NHS beds and services stretched bed-blockers can hit admissions; the dominio effect comes into play and the service begins to crumble.
Because perhaps after care is not readily available the whole system is under threat; remember 'for want of a nail the shoe was lost, for want of a shoe the horse was lost, for want of a horse a battle was lost?'
The British government claims an increase in beds being blocked is down to our increasingly aged population, people living longer, and other reasons but shies away from some home truths.
Here in my Yorkshire city the closure of an old hospital that provided sometimes long-term care helped start the rot.
Losing so many beds was always going to have a knock on effect.
Plans to improve care in the community soon failed.
Old wards at other hospitals across the city closed although to be fair new buildings such as dedicated cancer, cardiology and ophthalmology centres should have eased the situation.
But when you live in a city with a vast range of social and economic problems you can hardly compete or compare with a rural hospital located in a wealthy rural area of the country.
The NHS has to roll with the punches that often come from central government.
When you work for the NHS you soon realise that work for this health service provider long enough and you will see changes come around and around. In the end you will be back at square one but it will have been a costly game.
The cost comes in funding and in personal hardship to patients.
Bed blocking is a fact of the 21st century NHS.
Chief executives of various trusts across the country receive huge pay deals but tend to shuffle off in a few years with a hefty pay off tucked under their belt. Some then go on to take another job in the NHS and on it goes.
With a Tory government that wants to privatise the NHS, full stop, negatives such as bed blocking are widely publicised.
However the reasons for people staying in hospital after being classed medically fit are complex.
A great deal of time and money is spent working out who is fit and good to go although maybe not quite able to.
In some areas half-way home care centres are being established but look carefully at who owns and runs such centres and the warning signs are there.
Cuts in social care budgets and support workers mean some patients will invariably be stuck on a hospital ward waiting for discharge. That has a negative effect on the patient and their loved ones.
The only way to address bed blocking is:
Bed blocking news reporting tends to be ageist but it is not just older citizens that find themselves caught in an NHS trap.
Outbreaks of the winter vomiting bug close wards and prevent patient discharge to care homes. Young people also suffer strokes, heart atacks, brain injury and other illnesses which can require long-term aftercare.
And when you are stuck on a ward waiting for discharge your physical and mental well-being may suffer.
But when you are called a bed-blocker you may feel you have no identity, are just a waste of space and a drain on resources. That has to be wrong.
[A report by Labour peer Lord Carter highlights the problems of bed blocking while saying million of pounds can be saved by 2020 with a rethink of working practices. Me I wonder what Lord Carter was paid to undertake that study and justwhich decade NHS staff and patients will be taken back to on this never ending merry-go-round of change]
Prescribers are also conscious of costs these days and the drugs issued tend to be the cheaper versions.
Currently the cash-strapped and in demand NHS reportedly wastes a great deal of money prescribing drugs that are either not taken at all or taken ineffectively.
Discussing this latest measure on Question Time Thursday the issue of who owns drug companies and their drug pricing was part of the debate.
The NHS could become truly cost-effective if big Pharma were by-passed and the British health service developed and provided its own drugs. Perhaps that should have been invested in many years ago but surely it is still possible.
But the debate highlight came from an audience member who asked if the Queen would now have 'funded by the UK taxpayer' stitched into her crown and commented perhaps MPS should also have that phrase stitched onto their ministerial work wear.
NHS prescribed drugs will now carry a type of warning, similar to health warnings on packs of cigarettes, to remind people; but why taxpayer funded and not a reminder to 'please complete this course of treatment' or similar?
Prescriptions are not free to all in the UK and there is a charge of £8.20 an item, more for certain items. You can reduce costs if you are not eligible for any help with prescription costs by buying a PPC, prescription prepayment certificate; if you regularly are prescribed multiple items on prescription this can save you money.
At time of writing prescriptions are free or reduced;
But the above list may change.
Social security is under constant reform and prescription charges tend to increase but never reduce.
We are days away from Chancellor Osborne's 'emergency budget' when he is expected to announce a series of tough austerity measures to help fix the mess he inherited from himself!
Osborne is considering many measures including taxing disability benefits, a low blow even for this Tory government.
Tory priorities post May 7 have shown where their ideals lie and it is with corporations, banks and business.
Is labelling NHS drugs 'funded by UK taxpayers' vital and a priority? Will it work or will it alienate those who currently are in the 'free' group? You may not pay for your prescription now but over many years you will have helped fund the NHS with your taxes; and at that time you may have hardly used the NHS if at all.
But how much will this 'reminder' to take your meds cost and why UK taxpayer funded?
Today "The government has announced measures to clamp down on "rip-off" staffing agencies used by the NHS to plug gaps in nursing and doctor rotas."
The plan is to set a maximum hourly rate of pay. The government will also try to stop financially struggling NHS trusts from overspending to temporarily fill staffing gaps.
Sounds a plan on the surface but there is a great deal to consider.
Temp agencies have overheads and not all are ripping the NHS off. If an hourly rate cap is put in place will some agencies simply drop NHS contracts? There is nothing to say they have to supply temps permanently to the NHS.
As NHS contracts fixed or casual come under attack expect staffing issues inside the NHS to deepen.
Agencies that rely on the NHS to keep their business afloat may go to the wall. How many agencies are run by bosses with links to government we wonder? Will these numbers increase as the cap begins to bite? That is quite possible if you know or can anticipate the government's next moves.
When an hourly rate cap is put in place how will it be monitored? Is that going to increase bureaucracy in the NHS and introduce another tier of costly management?
How many agencies will simply reduce the fee paid to their temp rather than take a financial hit themselves? Employers of temps via agencies pay a fee which is made up of money for the worker and a fee for the agency. Shifting the pay to fee ratio may leave the temp out of pocket.
New temps may settle for less money but if you have been paid a particular rate of pay to cover nursing shifts on a temporary basis will you accept a drop in pay?
Agency nursing staff has been one of many thorns in the side of the NHS for some time.
There are situations when temps on wards are getting paid more than the permanent staff and this can cause resentment.
However a temp may work regularly or infrequently and miss out on perks. It is the usual case of 'swings and roundabouts'.
But when BBC News reports "NHS foundation trusts in England spent nearly £2bn last year on agency staff - more than twice the planned amount" you know something has to give. "Health Secretary Jeremy Hunt said the cost of agency and contract staff across the entire NHS in England last year was £3.3bn and staff costs had spiralled out of control. On one occasion, an agency nurse cost the NHS £2,200 for a 12-hour shift, and a doctor £3,700 for a 30-hour shift."
Expensive management consultants rip the NHS off big time. Created jobs under the vague term of 'project manager' pay over the odds to a favoured few.
But in the end if temps do not plug nursing gaps on NHS hospital wards who will suffer the most? The patient’s first and foremost but of course other staff suffer along the way.
Will the Tory government care if the NHS fails?
Why would they when most of them can easily afford private healthcare. They may use the NHS but in times of dire need they have other alternatives. The majority of the electorate do not.
NHS spending: how temporary staff keep the health service going
But the financial cost of agency staff is through the roof. This means that the 'bum' job for the day which may also be the most 'menial' will cost the NHS a small fortune.
And here's the rub; many NHS nurses also work as bank nurses. I know of one hospital director, a former nurse, a worked agency nursing at night to bump up money.
Do staff sometimes collude to enable overtime for each other? You can figure that one out for yourself.
The Financial Times reports "Simon Stevens has also indicated that the government will act to cap the soaring costs of hiring temporary nursing staff, claiming that the agencies that supplied them were “ripping off” taxpayers."
But ripping off taxpayers and the NHS sometimes goes hand in hand.
When you have one nurse who decides to mark a colleague's birthday by wasting time, money and resources printing off A4 'happy birthday' notices to then stick all over a ward and the ward manager ignoring the waste you know something is wrong.
During my years working at the NHS I experienced the good, the bad and the ugly but overall cannot recommend the NHS enough. Sure there are a few rotten apples but that's life.
Stevens needs to get to grips with the NHS and weed out the 'bad staff' especially at the top. Leaders must lead by example.
Who is Simon Stevens?
Simon Stevens, the health boss in question, is an ex-Blair adviser who is linked to a US healthcare giant according to the Independent. Stevens left the UK in 2004 after leading Labour's health care reforms, some would say off a cliff. He then spent a decade at the top of an American private healthcare giant before returning to the UK as the big cheese at the NHS.
Does he really care about the NHS?
The NHS is under threat from many sources not least the Transatlantic Trade and Investment Partnership (TTIP). PM Cameron has failed to offer protection for the NHS from TTIP and reassurances from the EU hold no water. Euractiv claims "Cecilia Malmström, the European Commissioner for Trade, has stated categorically that the UK’s National Health Service will not be threatened" but campaigners are working to ensure the NHS is protected.
Petition: Keep NHS Health Service Provision Fully Exempt from US/EU Free Trade Agreement.