There are blockages in the health production line we call the NHS

Edmund Stubbs, 11 December 2015

In a sense, NHS hospitals are health production lines. The sick patient is admitted, travels through the system and, unless beyond the help of modern medicine, should emerge in far better health at the other end.

However, at present this production line has major problems. Some say that the line is manned by insufficient numbers of de-motivated staff. Others say that funding shortages limit production and hinder the quality of work that can be achieved by the production process. A few might say that the ‘conveyor belts’ employed in this system divert into such a plethora of directions that it makes the baggage sorting at Heathrow look simple. They hold that as a result many patients get lost in the system or do not meet with the right operatives to sort them out; in short, that there is a lack of integrated care.

But what really harms the efficiency of the NHS’s health production line is a blockage at the end of the process which backs up through the system until it is stops many new entries at A&E and the ‘conveyor belt’ grinds to a halt.

This blockage is caused by a failure to discharge patients from hospital once medically fit to do so. These patients, unkindly called ‘bed blockers’, often have complex care needs that continue after they leave the hospital. They often cannot care for themselves at home and have no family able to even to keep an eye on them.

Presently, the responsibility for these patients lies with community NHS nurses and the social care system. In the government’s recent spending review social care has  once again been overlooked. According to the chief executives of both the King’s Fund and Nuffield Trust, despite the Better Care Fund’s additional allocated budget due towards the end of this parliament (which is truly needed now), the publically funded social care budget will fall in real terms.

It is true that George Osborne has allowed local authorities to raise council tax by two per cent to offset social care cuts, promising this could generate an extra £2 billion each year. However, many local councils are reluctant to raise taxes and so this figure could represent no more than a pipe dream. Far more pressing is the fact that, due to the different affluence of our regions, those with the poorest and least healthy populations, who are the most in need of social care, will have the least ability to raise money, increasing social care inequality.

We must face facts: our social care system no longer has the capacity to accommodate all those being discharged from acute hospitals. The distribution lorries of the NHS health production line cannot leave as they have nowhere to deliver their stock. This is a situation that can only get worse, and we will undoubtedly see increasing chaos in the system winter upon winter until considerable social care investment is provided.

Despite being a more expensive service than social care, the NHS has become a safety net for those who suddenly become too infirm and unwell to care for themselves. A&E is the weak point in the NHS’s expenditure control. Once you walk into an A&E department you become the NHS’s expensive problem; everybody knows this. However, until community and social care systems are properly funded, the weak and vulnerable amongst us will have no other option.