McTernan on Politics

Last year the House of Commons health select committee announced
that it thought the phrase “bed-blocking” was offensive and should
be changed. The Department of Health, showing the creativity and
innovative flair for which it is legendary, responded with alacrity
– in future it would refer neither to bed-blocking nor to delayed
discharge. Instead its wordsmiths produced the new jargon term
“delayed transfer of care”.

To be fair, this debate about terminology was in the context of the
development of a government response to a crisis in the health
service – the fact that every day 5,000 older people are forced to
stay in hospitals because there are inadequate care arrangements
for them in the community. True to form, the government’s Community
Care (Delayed Discharge) Bill proposes a mixture of stick and
carrot to get health and social services to tackle this problem
together.

There is some money to create extra social care capacity and under
the bill the NHS would have the power to fine social services
departments where patients continue to occupy scarce hospital beds
after their treatment has ended. However, cynics observe that it is
more stick than carrot, and that the carrot itself has been
genetically modified to taste like a stick. These plans have been
criticised by local government and have now been ambushed by the
House of Lords, where peers have called for a delay in
implementation at the very least.

The most extraordinary fact about this whole issue is how starkly
it illuminates a fundamental failure of our health and social care
services. This is not some small process issue which can be sorted
by technocratic tinkering with incentives. It is not merely the
numbers that count, although according to figures cited by Help the
Aged, those 5,000 older people per day amount to an estimated
quarter of a million older people who are affected each year. Nor
is it even about the time people have to stay in hospital – more
than a third are there for more than a month after they should go
home.

This is about the way that ageism is built into the very fabric of
our welfare state. It is a huge paradox. Welfare is primarily for
older people; half of all security spending goes to them and they
are the main client group of the NHS. Yet no services are designed
for them, with them or by them. From the minute a nurse or doctor
casually addresses their patient by their first name, a process of
infantilisation has started. That is the basis of all that is wrong
– we treat older people as though they are children. It is time to
rebuild our services with older people at their heart. And we
should stop trying to find proxies for their needs. Direct payments
for health care anyone?

John MacTernan is a political analyst.