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The bed blocking problem

This exercise will develop your understanding of the Formal Systems Model using the example of 'bed blocking' which is a big problem for UK hospitals.

Hospitals and Sheltered Housing in the Bed-Blocking System

Over the past few years, it has become common in the UK for elderly patients to remain in hospitals after their clinical treatment is complete because there is nowhere appropriate for them to go. So-called bed-blocking is an acute problem for the National Health Service (NHS). In December 2015, the Daily Mail, a government–friendly newspaper, wrote:

Department of Health statistics show that over the course of a year more than 680,000 elderly people treated by the NHS languish on wards for weeks, even though they are well enough to be looked after in a care home or at home with social services support. … Failure by ministers to tackle the problem, the loss of almost 50,000 council and private care home beds over the last five years, rising demand and social services budget cuts are blamed for the shambles. … Meanwhile, cancelled operations – directly linked to a lack of beds – have soared from 3,733 during the first quarter of 2000 to 4,881 this year. [1]

This kind of systemic failure has a high political as well as financial cost.

According to the Independent newspaper, the opposition Labour Party blames the delays and bed-blocking on cuts of £3.5 billion to social care budgets since 2010 causing more elderly people to be admitted to hospital instead of being cared for at home. [2]

Part of the problem is that the NHS pays when patients are in hospital, but when they are in community care the local council pays for them. The NHS and councils have different staff, separate budgets, and different priorities. Also, when a patient is transferred to a hospital in another county, another NHS trust must pay for them. To further complicate matters, if an elderly patient from one town is admitted to hospital in another they cannot access community care services there because they are not a resident. Instead, they must wait for someone from their local authority to come to assess them and organise care in their own community. This process can take a long time and it means patients can be stuck blocking a hospital bed for weeks. It was estimated in 2016 that bed blocking could cost the NHS £3.3 billion over the next five years [3]. Certainly the problem remains in 2018 [4][5].

Bed-blocking will be used as an example to give experience of systems thinking.


[1] Beezy Marsh, Bed blocking by elderly patients rises, Mail Online, 27-12-15

[2] Jane Merrick, NHS feels the strain as hospital bed-blocking by elderly patients hits record levels, The Independent, Sunday 22 March 2015.

[3] Sarah Knapton, Bed Blocking crisis to cost NHS £3.3 billion in next five years, The Telegraph, Tuesday 1st March 2016.

[4] Daniel Wainwright, Bed delay transfer figures reveal areas worst affected, BBC News, 23rd March 2017.

[5] Kat Lay, Hospitals are left without any free beds amid worst NHS winter crisis, 1st January 2018.

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Systems Thinking and Complexity

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