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I realise this is a very concise summary of a significant problem for patient flow in acute trusts but a significant cause of the delay in people who do not require acute hospital care and require long term nursing care is the bureaucracy of the process once the patient is deemed optimised for discharge. In my trust which has a very high very elderly population the delay and loss of bed days in care packages for people returning home pales into insignificance for those needing nursing homes (NHS). This is because anyone who is assessed as requiring NH immediately requires assessment for Continuing Health Care (CHC) has to have a Health Care Assessment followed by a Decision Support tool agreed with the family prior to being assessed to ensure they don't need CHC, and if they trigger the weekly CHC panel which we as clinicians know because of the high threshold that this requires will refuse the application. This adds weeks (and further work for an already stretched nursing staff ) to the process before the funding of care is established and the carers can find the NH of their choice which is a significant decision. These patients often become unwell and therefore not optimised adding to their inpatient stay although obviously not delayed. We have had many external organisation review flow at our trust but none have grasped this thorny issue apart from stating the need for discharge to assess beds. Despite ongoing lengthy discussions with the CCGs on how to develop these beds and ensure a pathway which prevents silting up of these beds they do not have the budget to do this and need to review in the next financial year "with a new strategy".
It appears that the only way to address this is similar to Queen Elizabeth in Birmingham for acute trusts to have wards dedicated to this process with a dedicated discharge team and social services, which we are doing but this means opening extra beds and finding the skilled staff to lead this and often taking them out of acute areas where they are also vital. It also leads to a further ward transfer for a vulnerable frail older person. I find it interesting that this bureaucracy is never highlighted or challenged.
Re: Sixty seconds on . . . bed blockers
I realise this is a very concise summary of a significant problem for patient flow in acute trusts but a significant cause of the delay in people who do not require acute hospital care and require long term nursing care is the bureaucracy of the process once the patient is deemed optimised for discharge. In my trust which has a very high very elderly population the delay and loss of bed days in care packages for people returning home pales into insignificance for those needing nursing homes (NHS). This is because anyone who is assessed as requiring NH immediately requires assessment for Continuing Health Care (CHC) has to have a Health Care Assessment followed by a Decision Support tool agreed with the family prior to being assessed to ensure they don't need CHC, and if they trigger the weekly CHC panel which we as clinicians know because of the high threshold that this requires will refuse the application. This adds weeks (and further work for an already stretched nursing staff ) to the process before the funding of care is established and the carers can find the NH of their choice which is a significant decision. These patients often become unwell and therefore not optimised adding to their inpatient stay although obviously not delayed. We have had many external organisation review flow at our trust but none have grasped this thorny issue apart from stating the need for discharge to assess beds. Despite ongoing lengthy discussions with the CCGs on how to develop these beds and ensure a pathway which prevents silting up of these beds they do not have the budget to do this and need to review in the next financial year "with a new strategy".
It appears that the only way to address this is similar to Queen Elizabeth in Birmingham for acute trusts to have wards dedicated to this process with a dedicated discharge team and social services, which we are doing but this means opening extra beds and finding the skilled staff to lead this and often taking them out of acute areas where they are also vital. It also leads to a further ward transfer for a vulnerable frail older person. I find it interesting that this bureaucracy is never highlighted or challenged.
Competing interests: No competing interests