The NHS is faced with a rising tide of demand for care combined with a tight rein on both NHS and social care finances. The impact of these pressures is seen across the health and care system. It manifests itself obviously in delayed transfers out of hospitals.
Year on year these delays are rising, with more people staying in hospital when they don’t need to be there. It has an impact on the care of some of the frailest and most vulnerable people and is the subject of continued attention from the media, healthcare regulators and politicians.
When media and commentators discuss this issue it’s only a matter of time before a certain horrible term is used – “bed blocker”.
The phrase “blocked bed” originated in the UK in the late 50s, driven by hospital clinicians’ concerns about a lack of beds. Its use grew between 1961 and 1967, when the elderly population increased by 14% while bed numbers remained static. In 1986 “bed blocking” made its first appearance in a British Medical Journal headline. Although it was not accepted as a medical term, by the 90s it was being widely used by health economists as a marker of inefficiency.
The term persists to this day, despite many efforts to move away from it, such as the Department of Health’s redefinition of delayed discharge and delayed transfer in April 2001.
Surely the time has come to remember to whom bed blocking is referring. These “blockers” are often older people, who are frail and vulnerable and who would like nothing more than to return home to their families. The phrase “bed blocker” puts all the emphasis, and blame, on the individual. The reality is that it is the system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home.
Language matters. How we talk about people reflects how we treat them and, in the health service, how we engage them in the care they receive. When we stop talking about people as people and instead use the language of the system (units, targets, blockers) we risk undermining the compassionate care the health service was created for and has delivered for almost 70 years.
I rarely hear anyone who works in the health and care sector use this phrase. Those working with and caring for people see the individual. They know their individual stories and what matters to them.
There is a quiet revolution under way in the NHS. It’s increasingly recognised that people should no longer be seen as passive recipients of their care but as participants in both the decision making process and the care they experience.
This is the right thing to do and what people want. But it is also a response to people’s changing health needs. With more and more people managing long-term conditions, sometimes more than one at a time, the old “patch ‘em up, ship ‘em out” approach is a thing of the past. The health service needs to work with people to manage their own care, and this means understanding their individual circumstances, wants and needs. To do this well also means looking beyond the health service towards their family life and other institutions like local government, schools and community groups.
The NHS Confederation brought together experts from across health and care to form a commission on improving urgent care for older people. In Sheffield, new processes discharge many more patients home, to be assessed there rather than in a mock environment in the ward. A saving of more than 30,000 bed days was recorded there over the first year and people report better experiences of care.
North east London foundation trust and the London Ambulance Service have together provided a home-based emergency assessment and care package for people who fall, resulting in only one in 20 recipients being admitted to hospital within 48 hours. There are similar examples in Derbyshire, Oldham, Greater Manchester, Norfolk, Aintree and right across the country.
The NHS has a way to go in making sure these examples make up a default approach. But the term “bed blocking” is unhelpful and arguably one of the most inappropriate terms in the healthcare lexicon. Let’s consign it to the dustbin and focus on what we know works both for the individual and the health and care system.
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Mind your language; they"re not "bed blockers" but older people
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