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Chapter 3 - What Is The

Diagnosis? Or Why Are

We Failing Our Elderly?

There are clearly substantial problems in the health and social care system but if

we are to have any chance of successfully addressing these problems, we need

to identify the reasons that lie behind them. Our research has identified a number

of root causes of the dysfunctionality of the care system in its current state which

we have grouped into seven headings below.

3.1 "Bed blocker" terminology

The terms 'bed blocker' and 'bed blocking' are much used in the press. It is

instructive, however, to consider exactly what is meant by this and, in particular,

to recognise that there are two sources of 'bed blockers'-those coming into the

acute sector for otherwise avoidable admissions, and those who no longer need

to be in hospital but are being kept in anyway. While no one would deny this

is a big problem for the health service, we believe that the term 'bed blocker'

is extremely unhelpful and demeaning in implying that the blame should fall

on patients themselves rather than the systemic faults that led to them being in

hospital when they didn't need to be. The term also carries an assumption that

the patient may be well enough to care for themselves but is somehow choosing

not to do so. 'Bed blocking' or 'bed blockers' dehumanises those who often

face poorer outcomes of care because they have slipped through the cracks of

the fragmented health and social care system. As such the use of 'bed blocking'

unhelpfully diverts attention away from those whose responsibility it is to design

and operate the healthcare system.

3.2 Lack of focus on prevention

When talking about how the care system should operate, one word was used far

more than any other in our interviews - prevention. Prevention at an early stage

is better for patients and much more cost-effective compared with treatment for

existing medical complaints. If the NHS and care providers were to focus more

on preventative care then significant cost savings could be made by reducing

future pressures on the acute end of the system, and so cut the number of delayed

transfers of care. A report by NHS England estimated that for every £1 spent on

preventative care it saved £12 in primary care.55 Putting preventative measures

at the front of the health agenda needs to be a priority for the NHS and social

care systems and would help to close the estimated £30 billion funding gap by


These figures seem unarguable but currently only 4 per cent of the total NHS

England healthcare budget is spent on prevention - why? The unfortunate truth is

that the system is just not designed to think about illness in this way. The system

is reactive in that it looks to treat patients rather than encouraging them to lead

healthier lives. One expert said to us: "The current [health and social care] system

deals well with problems of last century - helping those who fall sick. But [it is]

now about living with longer term conditions… [And the] NHS is very bad at

55 NHS England, The NHS belongs

to the people - a call to action

(June 2013)

Chapter 3 - What Is The Diagnosis? Or Why Are We Failing Our Elderly?



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