Recent days have seen stories in the media about horror in the hospitals as the drive to the financial margins has created tighter treatment margins with crises when the margins are reached and exceeded.
This is an edited item from 25 October 2010, "Bed Blocking For Dummies" and originated in a piece from 2005. Bed Blocking was exciting the BBC and other media because of the spending review.
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, or collapse or catastrophe is an open question.
Quote from the earlier item:
WHEN DID YOU LAST SEE YOUR GRANNY?
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. The carers come and go from 6 a.m. to midnight, and so do the medical and emergency services. 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.
The wider problems in the NHS have compounded the problems. Ladies who once rivaled 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 home as quickly as possible to manage and recover as best they can. Some soon return to the hospital, often as an emergency case. Where have all the convalescent facilities of former decades gone?
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.
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 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 fueled 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.
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.
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.
What will happen at the end of this year?