No one wants to be a 'bed blocker'. The best bed is always your own!
Isaac Samuels, co-chair of the National Co-production Advisory Group explains how he can be helped to stay out of hospital and Natasha Burberry, TLAP policy advisory gives some hard facts and practical advice.
For people with care and support needs like Isaac, hospital is often the last place they want to be, but it’s a place where he has spent considerable time faced with choices about whether it’s the right setting to manage his health condition.
One day at the beginning of a long hospital stay due to a mental health illness I got thinking why now, why here and what a waste of resources. I had six weeks to think about this, and I noticed during that time that nobody was speaking to me about what would make a difference and was there anything I could do to support myself to manage my care at home. For me, it’s about being around my own stuff, in my own bed and having my dogs with me. I started to see these patterns in the hospital and realised that if the system enabled me to self manage then all the above was achievable.
We have an opportunity to make a difference and support people to plan ahead and think about the best ways to meet their needs before going into hospital. What does that mean in practice? From my point of view, I would recommend:
1: Professionals listen to me and trust I understand what’s wrong.
2: Grant access to acute medicines that I can take at home.
3: I require a plan that includes whom to contact and what support I might need.
Some reflections from Natasha
Did you know that 48% of people over the age of 85 will die within 12 months of their first hospital admission? (NHSI). We also know that whilst people are in hospital and less active than they would normally be, physical ability often deteriorates which is never good. Infection risk is often high. Many of us know that hospitals are not safe environments unless you are acutely unwell, needing treatment and care only available in an acute hospital setting. It’s no surprise that most people, regardless of age and health condition wish to remain in their own homes, they don’t want to be a 'bed blocker' (what horrible jargon).
As Isaac said we have a real opportunity to make a difference to people, their support networks, the system and wider health and social care economy. From my point of view, I recommend that the health and social care sector ask itself the following questions:
- Are we really doing enough to ensure people’s wishes are being heard?
- Are we doing enough to avoid people going into hospital and ensuring support in their home or in their community?
- Do we have a recovery/treatment plan for people who are more at risk of hospital admission?
How do you start?
If we have good conversations we can achieve a better life for people and what matters to them. This means focussing our conversations on what’s strong more than what’s wrong. What does that person need and have around them that can support them to recover in the community rather than in hospital where people don’t want to be and can get stuck unnecessarily.
Learn from others
There are good examples of where professionals are trying to make a difference and avoid admissions by placing more services and skills in the community, such as the Reactive Emergency Assessment Community Team (REACT) in Ipswich which we recently heard about at the LGA Admission Avoidance event in London. https://www.local.gov.uk/tackling-delayed-transfers-care-ipswich-and-east-suffolk
Guidance to help in your role
We should remember that everyone wants a life, not a service and if we focus on the right things for that individual, it will make a difference.
The Think Local Act Personal Making It Real I/We Statements can really help to start a conversation about what matters to an individual (like Issac) and can challenge professionals to work differently together. Give it a read and see how you can adapt it in your conversations within the community to avoid hospital discharge or indeed if hospital admission is necessary (and sometimes it is) to plan for effective discharge.
The Local Government Association Revised High Impact Change Model can assist organisations with monitoring through a more person centred lens (professionals, commissioners and people working together to ensure an early conversation to improve flow). Please do take a look at this too.
As Isaac says, "No one wants to be a 'bed blocker'. The best bed is always your own!". There is much we can do to avoid unnecessary hospital admission so let's do it.