David Payne: “Bed blocking” is an offensive term

older_patient_hospitalSimon Stevens, head of the NHS in England, has warned MPs that delays in releasing older patients from hospital could continue for up to five years because of social care pressures. His comments were immediately reported as a “bed blocking” crisis.

The term bed blocking certainly trips off the tongue more easily than “delayed transfers of care,” but is the term derogatory? I think it is, implying that one patient is somehow denying another access to care.

I’m with medical tweeter Gordon Caldwell and others who responded to him in February:

 

Opposition to the term “bed blocker” is not new. In 2000 Christine Hancock, then head of the UK Royal College of Nursing, argued that the term implied “blame and nuisance value,” but that any blame “is with the NHS, not the person in the bed.”

Do patients feel guilty if their hospital stay is extended because of service pressures elsewhere? In February this year MS patient Poppy Hasted wrote an open letter to UK prime minister David Cameron in response to Lord Carter’s 18 month efficiency review.

Carter called for action to be taken on delayed transfers of care, which affects hospitals and trusts’ earning and spending capacity.

Ms Hasted told Mr Cameron in response to the review’s publication that her three week hospital stay was extended by a month because social services could not organise appropriate home care.

“I needed three visits each day, with two carers each time—a total of 31.5 hours every week—but social services found it nigh-on impossible to arrange for an agency to provide the carers. So I stayed in hospital and, although it wasn’t my fault, I felt guilty about being there.

“I knew I was taking up a bed I didn’t need any more and there was someone else lying on a trolley downstairs in A&E, or at home waiting for an operation, who needed it a lot more than I did.”

In the same month, according to a Daily Telegraph article, hospitals in the West Midlands and Northamptonshire were warning older patients who need residential care that they could face legal proceedings if they are not out within three weeks of being declared medically fit.

So if not bed blocking, what to replace it with? It’s a tough question, but the ideal term would be one that doesn’t label vulnerable patients with something negative. It certainly needs to be depersonalised. Delayed transfer? How about an acronym? PAT—Patient Awaiting Transfer? Answers on a postcard please.

Also, is it a politically imposed phrase, as Peter Smith suggested in the above tweet? It is hard to discover who first coined the term, but certainly it was in use by 1986—its first appearance in The BMJ. At the time Norman Fowler was health secretary in the Conservative government, and Ken Clarke had yet to succeed him and introduce the controversial purchaser-provider split. Might they or their ministerial team have coined the term?

Tellingly, the 1986 research paper Bed blocking in Bromley mentioned bed blocking’s effect on staff: “Nurses in one acute medical ward complained of having to be constantly vigilant to prevent ambulant demented patients from wandering and getting lost. On another ward so many patients were awaiting transfer to a long stay geriatric bed that the ward sister voiced her intention to resign.”

All the more reason to ban its use.

David Payne2

 

David Payne is digital editor, The BMJ

 

 

 

  • David Levine

    Calling the patients ‘bed-blockers’ is indeed offensive but the fact remains that hospital beds are blocked. If we’re honest, the real ‘bed-blockers’ are those individuals and organisations who
    aren’t providing the finance and skilled staff for proper care in what is called the community. Similarly, those who out of ignorance or stupidity have been responsible for closures of community hospitals and other step-down facilities.

    Let’s be clear though, this problem is not going to be solved by semantic arguments; the real offence is that acute hospitals are
    penalised financially for too many things that are often outside their control and that are often linked to lack of care elsewhere. They are penalised for excess re-admissions, they are penalised with marginal tariffs on admissions and they are penalised
    for emergency department and ambulance delays caused by lack of community provision more often than by dysfunctional processes that admittedly do occur within some hospitals.

    Perhaps the most offensive thing is that these penalties on
    hospitals already in impossible financial straits ultimately punish
    patients. For politicians to describe the penalties as incentives is truly insulting and dishonest. Worse, the fact that patients can stay in hospital is precisely a disincentive to the community to take action.

  • Dylan Summers

    There’s a difference though between speaking of a “bed blocking crisis” and labelling a particular patient as a “bed blocker”.

    The former strikes me a perfectly reasonable description of a crisis involving beds whose intended use has been “blocked”, and I see no problem with it – or with the grammatically preferable “bed blockage crisis”

    The problem only arises when a patient is accused of being the “bed blocker”, when in reality the whole medico-social care interface is the “bed blocker”.