As we near the annual party political conference season we can expect an eclectic mix of topical and traditional issues dominating the headlines over the next few weeks as MP’s do their best to convince the public why their vison is going to be best.
In the year the NHS turned 70, no doubt, in addition to Brexit, burkas and anti-Semitism, this political stalwart will once again be given plenty of attention as all parties discuss, debate and pledge how they will “save” this iconic British institution.
One of the biggest issues facing the NHS in recent years is the problem of ‘delayed transfer of care’ more commonly referred to as “bed blocking.” The scale of bed blocking impacts upon almost every area of healthcare provision and obviously has a knock-on effect on waiting times causing delayed or cancelled treatment, which can then exacerbate health conditions or slow recovery rates.
It’s been estimated that the problem is so bad it costs the NHS around £3billion a year and cancelled operations, due to bed blocking, are thought to cause around 8,000 deaths each year. So serious is the issue that this year, speaking at the NHS Confederation conference in June, Simon Stevens and Ian Dalton, the Chief Executives of NHS England and NHS Improvement, acknowledged the problem bed blocking causes and announced plans to improve patient care by cutting long hospital stays.
There are many causes of bed blocking, but one of the biggest is elderly and disabled patients waiting for their homes to be adapted before they can be discharged. The healthcare industry has been aware of this for many years. Indeed, in 2012 the BHTA (British Healthcare Trades Association) commissioned a report from the LSE (London School of Economics) into the cost benefits of investing in homecare. The report concluded that if investment in homecare aids and adaptations was at the heart of its adult social care reforms it could yield a potential annual saving of £1,101 per person per year. In March last year, Dr Mark Spencer, Chairman of the NHS Alliance, highlighted the correlation between effective primary care (social and community care) and secondary care (hospitals) as part of the solution to an overstretched health service. The NHS Alliance also highlighted the huge cost savings (£2.5 billion) if patients could be discharged from hospital more quickly into a social-care environment.
With something as large and as multifaceted as healthcare, which encompasses many differing departments, all with their own budgets, pressures, protocols and agendas it will be easier said than done to integrate effectively primary and secondary care. To help make this process easier, this month, coinciding with the political conference season, the BHTA has published a position paper titled ‘Action on Delayed Transfer of Care’. The paper details some practical ideas on how to reducing bed blocking, improve care and cut costs. The suggestions tabled are all practical, achievable and offer real advantages to improving healthcare.
Things like more rapid assessment in hospital, addressing the shortage of Occupational Therapists, and greater provision of Trusted Trained Assessors could all help to address the problem. Everyone agrees that greater integration of health and social care systems is crucial. There is already some evidence of how delayed transfer of care can be reduced, and cost savings achieved to fund other aspects of healthcare, where relevant budgets are combined, as in Greater Manchester. Investment in research and development has also enabled British manufacturers and suppliers to provide some of the best equipment in the world to help more elderly and disabled people live independently out of hospital.
There also needs to be a fundamental overhaul on the way healthcare and social care is procured. Many public sector contracts are awarded using what is called the ‘Most Economically Advantageous Tender’ (or MEAT for short). Too often current procurement practice does not allow for cost efficiencies to be taken into account when buying or evaluating supply contracts and tenders if the beneficiary is a different department or healthcare organisation to that of the purchasing budget holder. Invariably lower prices tend to override speed of delivery when it comes to the supply of community care equipment. This often proves to be a false economy when other costs are factored in such as additional community nursing needs, respite care provision and all the costs that follow from delayed transfer of care.
Therefore, procurement policies need to change to promote speed of delivery and long-term cost/benefit analysis for all involved. Primary care providers need to change from a strategy of ‘cost effective procurement of goods and services’ to one of ‘cost effective delivery of goods and services’. Key to this change will be the ability to identify any cost savings and efficacies in other areas of healthcare and beyond. These savings can then be factored into the overall evaluation of future healthcare procurement.
In summary, a more rapid assessment of the need for community equipment and a more appropriate procurement process, prioritising speed of delivery, could assist significantly in reducing the scale of the problem to everyone’s benefit. As someone who was part of the team that drafted this BHTA bed blocking paper, I would be the first to say it won’t be quick or easy. However, if the key suggestions are embraced, implemented and persevered, there is a real opportunity to reduce considerably the instances of bed blocking and all the misery and waste associated with it.
This article was first published in the Newcastle Journal on 6 September 2018
A Pdf copy of the BHTA ‘Action on Delayed Transfer of Care’ paper can be downloaded HERE