AS Scotland’s NHS battles through one of the worst crises in its history, both Unionist parties and the SNP/Green government are agreed on one thing: bed blocking is a serious contributing factor.
As A&E wait times seem to hit new record highs with every passing week, the issue of blocked beds (or delayed discharge) comes more and more into focus. But what is often excluded from the picture is Brexit, which experts say has exacerbated the problem.
What is bed blocking?
Bed blocking, or delayed discharge, is the term used when patients are ready to leave hospital but they are unable to as the appropriate care package is not in place.
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SNP MP Dr Philippa Whitford explained that as people are living longer they are picking up more and more ailments. When one becomes an acute problem requiring hospital treatment, it being fixed does not necessarily mean the person is fit to “just go home and fly solo straight away”.
“They either need help in the short term, or medium, or even they need help in the long term,” Whitford explained.
“That’s where we can’t get those people out of hospital. We don’t have the support in social care at the moment, and a lot of that is lack of staffing, and a lot of that is driven by the loss of freedom of movement.”
Both Labor and the Conservatives have hit out at the “appalling” levels of bed blocking in Scotland – which are forcing up A&E waiting times – and Health Secretary Yousaf (above) has conceded that delayed discharge numbers are “far, far too high”.
Labor have claimed that bed blocking cost Scotland’s health service some £111 million between April and October 2022, saying that the costs run into the billions over the last decade.
And Scottish Tory MSP Dr Sandesh Gulhane has said the “knock-on effects of delayed discharge are equally damaging, as other patients who desperately need hospital beds can’t get them”.
But what both the Unionist parties failed to mention is the impact of Brexit, which experts say has exacerbated the problem.
How has Brexit impacted on bed blocking?
Put simply, Brexit has reduced the number of staff in the social care sector, which has made it more and more difficult to discharge people from hospital into an appropriate setting.
The harder it is to release people from hospital into social care, the longer A&E wait times for bed space becomes.
“The social care system was dependent very heavily on migration within the EEA [European Economic Area] to increase its workforce,” Mark Dayan, a policy analyst at the Nuffield Trust, told The National.
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“Since the EU referendum and particularly in the last five years or so you’ve really seen EU recruitment tail off. Unfortunately so far non-EU levels of staffing haven’t really risen to compensate for that.”
Dayan added: “I think in some respects the Scottish social care system is less stressed and slightly better funded than the English system, but it certainly has its difficulties and there can be little doubt that Brexit, and the slowdown in general of European migration, has added to the problems there.”
Dayan – who co-authored a report published in December called Health and Brexit: six years on – said that leaving the EU had “exacerbated several of the problems that the NHS faces that are driving the current situation: care outcomes that frankly aren’t great, lengthening waiting times, and massive pressure on health service budgets in all UK countries”.
The UK Government’s post-Brexit immigration system has put incredible strain on staffing levels in the social care sector.
“You’re expecting what are often quite small, individual care homes or care companies to manage the home office and become visa sponsors for the skilled workers’ route for health and care,” Whitford says. “That’s just beyond some of them.
“[Before Brexit] they could have just recruited, they could have sent adverts to Europe, but now they have to take on the home office to bring more people in.”
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And it is not only the care sector facing issues with the home office.
Dr Julia Patterson, the chief executive of EveryDoctor, told The National that medics in their network had been waiting as long as six months for paperwork which will allow them to actually start their job in the NHS.
“The Home Office is administratively just in a totally chaotic state,” Patterson said. “It just makes no sense. It’s simply an admin backlog and they need to tackle it urgently.”
The care sector
“You’re not going to fix the NHS if you don’t fix social care,” Whitford said.
The SNP MP highlighted how caring as a profession was seen as low-skilled and workers were often low paid.
She said that without fixing the profession it would be hard to retain care staff, even if they could be attracted to come to the UK from abroad.
“You’re not going to catch up the backlog if you don’t fix social care because you can’t get anybody in. You’ve got to fix social care. You can’t fix the NHS in isolation,” the SNP MP said.
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While the Scottish Government has proposed plans for a National Care Service, it has faced fierce opposition from across the spectrum, from trade unions to local government to private interests.
The Convention of Scottish Local Authorities (Cosla), which represents Scotland’s 32 councils, has called on the Government to ditch the plans and pass the allocated funding to local government instead.