Blocking beds is not the fault of the elderly
‘Bed-blocker” is a highly offensive term, with its implication of some (usually older) person who does not require to be in hospital utilising precious medical resources that would be better deployed for some (usually younger) and more deserving case. Still, this has become a pressing issue with, as reported last week, an additional hundred thousand days “lost” from delays in discharging patients this past winter compared with the previous one.
There are no surprises for guessing the probable explanation, vividly illustrated on the very useful Qualitywatch website (qualitywatch.org.uk) with a graph of the vertiginous drop, by almost a third, in the number of adult social care staff – from almost 70,000 to just 48,000 – in the four years up to 2015.
This was George Osborne’s doing: his austerity cuts of 2010 knocked £18billion off local authority budgets made necessary by Gordon Brown’s profligacy that left the Treasury cupboard bare. And it is going to get worse for, as also anticipated this week, by 2021 there will be a shortfall of nearly 30,000 care home beds. It is not necessary to be a gloom-and-doom merchant to realise this is seriously bad news.
Writing on this matter back in August, our esteemed columnist Judith Woods proposed a social care penny on income tax. Those who might disagree should take a look at the graph and come up with a better idea.
Diabetes muddle
My observations last week on how oldies in particular are having their lives complicated by being wrongly labelled as having diabetes has prompted requests for further clarification. The confusion on this matter is compounded by there being no fewer than four different measurement criteria – where the cut-off point for diagnosis can be a blood glucose of 7.0mmol/l (or 126mg/dl) or an Hba1c of 48mmol/ mol (or 6.5 per cent or over). So sticking with the first measurement, the threshold used to be higher, at 7.5mmol/l. The arbitrary decision to lower it inevitably increased, by several tens of thousands, the numbers diagnosed as having diabetes without the slightest evidence this would be to their benefit.
Next, the average (or mean) blood sugar rises with age, from 5 in middle age to 6mmol/l in those in their sixties and beyond. This natural upward trend was not taken into account (as it should have been) when setting the more stringent threshold resulting in oldies being over-diagnosed. This could be avoided by the simple expedient of reverting back to the earlier threshold of 7.5mmol/l.
This may all seem pretty tedious, but it is very important, as the downward pressure on those diagnostic thresholds (as has also happened with cholesterol) has been a major factor in the medicalisation of the healthy to no one’s advantage other than, for obvious reasons, the drug companies.
That aside, the mislabelling of diabetes carries a heavy financial penalty, doubling life insurance premiums and the cost of travel insurance.
Growth consensus
The lady with discomfort “like a thorn” under the thumb nail, which progressed to an exquisite sensitivity at the tip (“as if immersed in burning fat”), has prompted a near consensus from several specialists. The probable diagnosis here is a benign growth of the sensory nerves involved in temperature perception known as a glomus tumour, which, being so tiny, can only be detected on an MRI scan. Excision is curative.
The only dissenting voice, a retired consultant from Newcastle, suspects the unusual detail of the pain being brought on by a featherlike touch but not intensified when the thumb is gripped may well be significant. This is suggested rather of causalgia, a hypersensitivity syndrome caused by nerve damage that may follow even a minor injury.