Monday 25 October 2010

Bed Blocking For Dummies

Another from the personal archive; from 2005 and this is reflected in some parts of the text. It is 1500 words I’m afraid but it does cover the issue. Bed Blocking is now exciting the BBC and other media because of the spending review. We have been here before but then the issue attracted less attention and tears.

In the last dozen years the pre-conditions for serious problems have been in place but have gone critical only a couple of times, mercifully avoiding the worst. Whatever planning may have been done in the past there have been some significant developments quite recently so the figures have been going the wrong way. This means that critical phases will occur more often. Just when the tipping point might occur into chaos/collapse/catastrophe is an open question.



The ambulance arrived in the early hours of the morning, a routine event; recently there were four visits by paramedics and ambulances in one day. The reason is not mobs of drunken yobs beating out each other’s brains or local addicts overdosing, it is a quiet, well behaved, ordinary and indeed gentle group of neighbours who fall or have a medical crisis.

The problem is their longevity and its consequences. When the block of retirement flats in which they live was first occupied a decade ago, it was different. It was designed for the active retired, pensioners who were mobile, needing little care, who preferred to avoid the costs and problems of running a too large a house and garden.

They wanted to cash in on their former home to keep more of their pension for their own pleasures or protection, and to enjoy a bit of quiet easy comfort, as well as cheap warmth.

It is not just that the original occupants have grown old; there has been a substantial turnover, as in other sectors of the housing market. It is that the most of the new people are older, frailer and more dependent on personal support.

The carers come and go from 6 a.m. to midnight, and so do the medical and emergency services. Once, none had the call pendants provided for those at high risk, now there is a dedicated communications aerial to cope with the number needing this precaution.

Nationally, the number of call-outs for the ambulance services has increased sharply in the last decade; this is one reason for the added demands. Perhaps the number of man hours and the real costs involved for the 50 or so occupants of the flats is now roughly the same as for a 100 Bed Residential Home.

The wider problems in the NHS have compounded the problems. Ladies who once rivalled each other in their fashion sense and men in competitive sports now try to cap each other’s trolley horror and medical disaster stories.

They are many and various, one who visited her Family Doctor for a routine prescription discovered that the local hospital had declared her to be deceased and all her medical records had been deleted from the relevant NHS systems; so the undead stalk the land.

A desperately sick man died quietly on his trolley after a 72 hour wait. Treatment that is nearly too late, or long delayed, complicates long-term recovery, and when attention is given for the immediate issue they are packed off back to their flats as quickly as possible to manage and recover as best they can.

The local hospital has enough trouble with bed-blockers. Some soon return to the hospital, often as an emergency case. Where have all the convalescent facilities of former decades gone?

The granny-stacking flats put up by developers are rarely equipped for the disabled, nor are they staffed to deal with anything other than buildings and site management. The bungled attempt to regulate residential homes more closely by New Labour, that caused so much personal damage and distress, wiped out a huge number of temporary and permanent beds and accommodation for the elderly infirm when the owners decided to take the money and run as property prices rocketed.

In the meantime the major erosion of the income of the old by stealth taxes through the machinery of local government and national finance means they are less able to care for themselves. The effects of other regulations, Health and Safety and Euro inspired instructions and admonitions have added to costs and prices.

The petite elderly lady who lay on the floor for hours had several full grown healthy young people in attendance who were forbidden by their conditions of service to lift her onto her bed.

She had a lot to say on the subject later. Apparently, the one ambulance in the area of the Trust that was equipped with the relevant lifting gear was busy with a long list of potential clients. The cost of that little business was estimated at £900, and she does fall over quite often while waiting for her wonky knee to be looked at.

In all the planning for new housing demanded by the government, intended to be in the hands of the forthcoming Regional Governors and their development directorates, the bit that is missing is what to do about the old.

The provision of half-way house accommodation, developments of self contained units, but with built-in support services and meals provision, and the further stage of residential facilities for those requiring rather less than full nursing home needs is absent from any visible state thinking.

Those in the retirement flats are often the lucky ones, where there is at least some company and administrative support, because for every one of them there may be twenty or more living alone and in virtual social isolation in houses that few can manage or maintain. Some will succumb to hypothermia because of the heating costs; others will suffer from malnutrition or dehydration.

The vagaries of the housing market add to the complexity of the problem, as do the serious dangers of boom and bust. In boom, there is a tendency to hang on for the best possible price, and that is always a little too long. In bust, the old who cannot cope also cannot sell their homes in the new situation.

Because of what has happened already it is possible that one way or another over the last few years the number of ordinary houses and properties effectively removed from the market and occupied by single old people needing daily care is more than the numbers of new properties demanded by New Labour as vital for “new needs”.

A lot of these “new needs” arise from the expansion of the holdings of second and third homes and the buy-to-let sector fuelled by cheap credit. The people who benefit from this surge in property buying are subsidised, probably, through the tax and benefits system far more than the struggling pensioners, and the ones who benefit from the ramp include almost all of the current political and media elite.

It is not surprising that New Labour seem to care so little for the old. One of the prime industrial dispute tactics of some of them during the 1978-79 Winter of Discontent when they were young militants promoting the Workers Revolution was to have lightning strikes of care workers in local authority nursing and residential homes and in special schools, where the deaths could be written off as “necessary casualties”.

We know that the slow disintegration of the pensions system since 1997, part of the assault by Brown and New Labour on the Lower Middle Class, the “peasants” as they engagingly call them, will create intricate problems in the decades to come.

More pressing for the immediate future is a disaster about to happen; one serious pandemic of influenza could be enough. Although the government may well put it down to a necessary conjunction of statistical trends relating to demographic factors inherent in the age structure of the population, the electorate may take the view that the state has a responsibility.

Given the state of the A&E and geriatric facilities in most hospitals, the serious and growing problems in community medicine and general practice, the tipping points from pressure to crisis and from crisis to disaster are perilously close to daily experience.

To add a stomach churning thought the limited provision of mortuary, pathological, coroners, and burial and cremation services could resurrect in the present the nastier effects of the great plagues and geophysical disruptions of the past.

There may be worse, for the increasing numbers of the criminal elements that prey on the old already with no fear of arrest, or of being troubled by Police Forces who have other targets to meet, will be very active, stripping the bodies and ransacking their homes while the dead lie and decompose for days or weeks in their isolation.

This would not be new, during the Second World War Blitzes the looters often arrived at the scene first. In the summer of 2003 in France, that paragon of social welfare provision and human rights, a long hot spell during the holiday season did for thousands of the old who were living alone. In the USA, Hurricane Katrina taught a few sharp lessons in complacency.

The only considerations that will worry the government, of course, are the poll ratings amongst those able to vote, the question of how the young voter will react, and the serious worry that the sudden availability of up to a hundred thousand houses could crash the property market in the run up to the next general election. In the meantime we give almost all our attention and thoughts to the media excitements of the day.

In the night, the ambulances come and go, and the carers wake long before the dawn.


Christmas is coming.

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