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Can we avoid wasting money in health & care?

24/01/2022

We are all aware of the ongoing issue of bed blocking. An issue that costs the NHS more than £40million a week(!)! Are we apportioning blame in the wrong place?


We all blame the Government. The Health & Care Bill is currently wending its way slowly through Parliament, so will be months/ years away from implementation. But is the Government responsible for the current problems?

When you actually look at the current status, there is already the means in place to alter the status quo, to improve it for the better and dramatically reduce the delay and therefore waste of money.

Joint strategy already in place….

The Better Care Fund (BCF)- introduced in 2013- requires the NHS, public health and local authorities to enter into pooled budget arrangements and agree an integrated spending plan, and a joint health & wellbeing strategy for the local population (2).

The root cause of bed blocking is that people are waiting for change at their homes, to enable them to be discharged. The people largely responsible for that- the housing and social services officers within local authorities- who administer the funds for social care and home adaptations, themselves acknowledge the problem is not due to shortage of funds. It is due to process.

people are having to stay in hospital whilst they wait for changes to their homes

Yet the real question is: why is the process of the BCF not being delivered? Why does there seem to be a lack of integration, joined-up thinking, joint strategy?

We have the means to change

Historically, the public sector tends to continue with the status quo. It is risk averse. It does not like change.

One thing we have all learnt from Covid is that we can find new, better ways of working. We can be brave enough to try something different.

Some local authorities have already taken seemingly small steps that have made a massive difference to the situation in their area. The mechanism to enable those small changes outside of the auspices of the Disabled Facilities Grant is in place in almost all local authorities- via Regulatory Reform Orders.

For example, monies have been used to fund a dedicated Occupational Therapist within the hospital, to liaise and arrange little things that enable someone to go home. 

Some Authorities have taken even things as small as cleaning and decluttering into the criteria. 

They have appreciated that not every adaptation- for example addressing stairs (as an aside, one of the top four funding allocations)- need require structural alterations and all the associated time delay, impact on other members of the household etc: they have provided a stairclimber from stores rather than organise installation of a stairlift or through-floor lift.

a stairclimber makes going up and down stairs easy

Sadly, time and again you see something positive in one area, that delivers better outcomes for the local people and better value for the local authority, that is lauded and held up as exemplar(3).

No-one grabs the bull by the horns and says:” Yes, great idea. Let’s try and roll it out regionally/nationally.”

reference sources:

(1) based on £500/patient/bed, and 10% of 124,000 hospital beds currently being blocked (statistics from Foundations, https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/)

(2) https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/better-care-fund/about-the-better-care-fund/

(3) https://www.nhs.uk/nhsengland/keogh-review/documents/quick-guides/quick-guide-discharge-to-access.pdf

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