Chapter 4 - What Are
Our Proposed Solutions?
It is clear that there are very substantial problems hard-wired into the health and
social care system. As such, it would be foolish to assume that with the sweep of
a wand everything will be better in the next few months. But an acknowledgement
of the scale and complexity of the challenge is not a reason to delay the drive to
make the constituent parts of the system interact in a way that works for, rather
than against, the interests of the most vulnerable. So while we do not suggest that
the recommendations we make in this chapter would be a collective panacea,
they will definitely move the country further down the right path.
4.1 Changing the language around "Bed blocking"
We argue that 'bed blocker' and 'bed blocking' are unhelpful terms that point
the blame for a serious problem at the patients rather than the real culprits, the
systemic problems of the health and social care system. We therefore believe that
it we need to change the language around this issue in order to make clear who
is and is not responsible. Whilst the term 'delayed transfers of care' is used often
used instead of 'bed blocking' we believe it doesn't portray the whole picture.
This is because 'bed blocking' has two aspects- too many people coming
into acute care with avoidable conditions and too many people waiting to be
discharged. We therefore propose that the phrase 'preventable bed occupation'
is used instead to describe the phenomenon.
Recommendation: Encourage the media to use the phrase
'preventable bed occupation' instead of 'bed blocking'.
Impact: This would:
• Emphasise the importance of prevention in controlling avoidable demand
for acute services.
• Re-focus the culpability away from blameless patients and onto the flaws in
4.2 Increased powers for Health and Wellbeing Boards
Health and Wellbeing Boards (HWBs) have been a positive local structural lever
for change but they are still in their infancy. Despite their relative nascence most of
those we interviewed said they thought they are playing a very positive role and
this is backed up by our survey which found that 75 per cent thought that their
HWB had made a noticeable or substantial improvement to health and social
care in their local area. The most common reason ascribed to the success of
HWBs was that they bring together leaders at the local level - as one interviewee
said: "health and wellbeing boards literally got representatives from different
organisations sitting round the table, and that's a crucial first step".
We believe that HWBs are well placed to play a key role in leading the required
strategic shift to prevention if, as one Director for Public Health put it, they are:
"given the teeth to do it." We also agree with those we spoke to who argued that
enhanced powers for HWBs would be most effective when such powers were
combined with "strict criteria" for what success looked like.