Bed blocking 1

More occupational therapists to deliver better and quicker assessments, better integration of care and social services and improvements to procurement policies are just some of the solutions suggested by the British Healthcare Trades Association’s (BHTA) to address the problem of Delayed Transfer of Care.

Commonly referred to as ‘bed blocking, the issue has an extensive impact on healthcare provision across the board, with knock-on effects on waiting times causing delayed and cancelled treatments which can exacerbate health conditions and slow down recovery rates.

Lord Chris Rennard, BHTA Director of Communications, commented: “Delayed transfer of care causes distress for patients and their families and is a particular problem for many older people, especially those who are frail and may have dementia. Their conditions often deteriorate whilst in hospital and there can be significant muscle wastage due to lack of physical activity.”

According to the NHS England statistics detailing the number of delayed days across NHS Organisations for each month, the figure was 144,997 in April 2018, with a peak in October 2016 of over 200,000 days for the month.

Amongst the reasons identified for delayed discharges in April 2018, three key causes were patients awaiting completion of assessment, awaiting residential home placement or availability and awaiting community equipment and adaptations.

The paper, Action on Delayed Transfer of Care, contains a number of suggestions to address the issues and reduce bed blocking, freeing up stretched resources.

One of the key areas highlighted by the paper as requiring change is in procurement, where it says improvements to policies could speed up delivery of vital community equipment and allow people to leave hospital quicker.

Importantly, the paper states that delayed discharges should be treated as emergencies, with needs for equipment quickly identified and generally provided within five days.

Additionally, the Trade Association says that an improvement in the management of Loan Stock Equipment could also help to reduce bed blocking through the use of automatic identification and data capture technology to provide better management control.

“More rapid assessment of the need for community equipment and a more rapid procurement process could assist significantly to reduce the scale of the problem to everyone’s benefit.” Mandie Lavin, Director General of British Healthcare Trades Association

Alongside changes to procurement policies, the importance of integrating services and combining health & care budgets are also emphasised in the document.

A number of case studies from areas such as Norfolk, Kent and Manchester emphasise the positive outcomes enjoyed by patients and cost savings seen across services via effective integration.

On the contrary, the BHTA notes a case in Durham where the County Council awarded the contract for the supply and maintenance of stairlifts to a supplier based on price rather than taking other considerations, such as the speed of installation, into account. The result was long waiting times for the supply of vital equipment needed for individuals to leave hospital and return to the community, having substantial cost implications on the NHS.

With assessments playing a critical role in helping patients transition back into the community, the paper calls for more occupational therapists to enable better and more rapid assessment within hospitals of patients’ immediate needs outside hospital.

In addition to the need for OTs, the BHTA proposes there is a case for trusted assessors to assess equipment needs when OTs are not available.

As well as procurement and integration, the paper also suggests that tax incentives should be introduced to encourage people purchasing homes with a view to retirement to plan ahead and make adaptations in anticipation of future needs.

Writing to Simon Stevens, Mandie Lavin, Director-General of the BHTA, said: “More rapid assessment of the need for community equipment and a more rapid procurement process could assist significantly to reduce the scale of the problem to everyone’s benefit.

“When needs have been assessed, tenders for the necessary equipment are very largely based upon price (inevitably) and to a lesser degree on quality. But speed of delivery and the opportunity to reduce ‘bed blocking’ should also be a significant priority. We believe that where there is an issue of ‘delayed discharge’ then the supply of equipment should generally be treated as an emergency.”

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