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