PATIENT TRAPPED FOR FOUR YEARS IN HOSPITAL
Revealed: the full, distressing scale of bed-blocker fiasco
A PATIENT who is medically fit to leave hospital has been waiting for over four years to get out, astonishing new HSE figures reveal.
Moreover, that patient is one of 13 who has been kept for over a year in badly needed acute-care beds, the Irish Mail on Sunday can today reveal.
Figures, from the past two years, show that 119 people have spent more than a year on the ‘Delayed Discharge Patients’ list while fit enough to leave.
They are called ‘bed blockers’, and
play a key role in the health service crisis because they prevent patients on trolleys or those in need of pain-relief operations from getting a bed.
But the patients on the list – who have not been identified – are taking up the spaces through no fault of their own.
While their doctors have said they are clinically ready to leave hospital, they are kept in because they don’t have access to a respite bed or a nursing home place – or they may need adjustments to their home.
Overall, those on the list spent 536,766 nights in hospital in 2015 and 2016.
This shocking number of wasted beds could have facilitated 107,000 hip operations, based on the number of days a hip patient typically spends in hospital.
Or they could have allowed for over 500,000 hernia surgeries, or more than 100,000 knee operations since the start of 2015.
To put the figures in context, last year more than 37,000 such elective operations were cancelled due to hospital over-crowding, according to figures supplied to Fianna Fáil by the HSE.
Patient advocate Stephen McMahon was critical of the long time spent by certain patients in hospital, saying the problem shows gaps in the care system. Mr McMahon, of the Irish Patients’ Association, said: ‘This has a terrible impact on patients. They would be anxious, concerned about hospital-acquired infections and also worried about being over-exposed to different problems.
‘We don’t want the patients, or their families to feel this is their fault. It’s not their fault, it’s the system. The needs of the patient for care in the community or wherever is appropriate are not being met.’
He said the high number of hospital beds occupied by people who should not be there puts strain on the hospital’s ability to deliver elective surgery.
It also emerged from the HSE figures that two of these being kept in hospital though they are fit to leave have been waiting over two years, and a further 34 have been waiting for more than six months.
The patient enduring the longest delay has been waiting since September 10, 2012, or to put that in context, a full year and three months before Ireland’s Troika bailout ended.
And a shocking 1,017 spent more than 100 days in hospital before they could leave.
The figures tracking the number of ‘delayed discharges’ – released under Freedom of Information rules – show that once a patient is put on the list they spend, on average, just under a month or 29 days waiting to get out of hospital since the start of 2015.
This average figure was 37.5 days in 2015 but it has been reduced to 22 in 2016.
However, the figures also show that the number that the HSE publishes every month is actually an underestimate and does not reflect the full strain that hospitals are under.
This is because the monthly figure is provided as a snapshot of the problem on the last Tuesday of every month, but doesn’t reveal the total number of individuals who are registered on the list on a monthly basis.
The latest published figures show 469 people currently awaiting discharge, despite being well enough to leave hospital.
However, a second, registered list shows the number throughout the month as 752.
Over the two-year period, the difference between the two figures is in the region of 15%, when you eliminate people who are registered to be released the same day.
The HSE says that the registered figure is available to them, and is the one that informs their policy initiatives.
The health executive is attempting to tackle the issue, and has seen significant progress in the number of bed nights lost, according to these figures. They show that the number dropped from just over 335,000 in 2015 to just under 195,000 last year. But while the number of nights each person spends trapped in hospital is reducing, the number of patients affected by the delays is staying relatively stable, according to the HSE’s registered numbers. Yesterday, Health Minister Simon Harris defended a nascent plan to accommodate some patients in prefab buildings that are attached to overcrowded hospitals.
And responding to the number of delayed discharges, a HSE spokesman said the published numbers are a ‘snapshot’ of the numbers taken on the last Tuesday of every month to enable direct comparisons.
However, observers have questioned why the full registered numbers are not published so the public can understand the true extent of the problem.
A HSE spokesman said: ‘There are no invisible patients in terms of delayed discharges. The difference
‘The needs of the patient are not being met’ ‘Most people lacked home care support’
between the published number and the registered number is that the published number refers to the number of delayed discharge patients at a specific point in time.
‘The registered number is the total number of patients added to the delayed discharge list during that time.’
Asked why the published list is smaller than the registered list in 23 of the 25 months surveyed, he stressed that they don’t show the full picture and explained: ‘Patients are being added to the list and taken off on a daily basis.’
The numbers do show patients in general are spending less time trapped in hospitals, with the average stay dropping from 38.48 to 22.8 between 2015 and last year.
The HSE spokesman pointed to the growing population as one reason why the numbers remain stubbornly high.
Mr McMahon, of the Irish Patients’ Association, said: ‘It would be good to see the full list of numbers published in tandem with the numbers of patients on trolleys in the emergency departments.
‘This B-list of numbers or shadow list tells us exactly what’s happening in the hospitals, it’s disappointing this is not public information.’
While the FOI documents do not reveal the ages of any patients on delayed discharge for privacy reasons, it is accepted that the majority are elderly patients. Justin Moran from advocacy group Age Action said: ‘Most of the cases we come across where people are waiting for discharge are because of a lack of home care supports.
‘The key issue is to enable older people to get out of hospital and back home. It’s hard to believe the HSE or the department understands the sheer scale of the crisis older people face in getting home care supports when you see that, despite rising demand, our ambition in 2017 is to provide fewer home help hours to fewer people than we did six years ago.‘
In relation to the person who has been waiting to leave hospital since 2012, Mr Moran said based on his experience with these problems, it could be someone waiting for support with complex needs, or even a younger person waiting on a rehabilitation bed.
He said: ‘Someone with an acquired brain injury can be waiting years for a bed in the National Rehabilitation Hospital for example.’
A survey carried out by Age Action in partnership with Alzheimer Society of Ireland and the Irish Association of Social Workers in 2015 found 48% of the older people marked ‘delayed discharge’ were waiting for home supports.
The Irish Hospital Consultants Association’s Martin Varley said the delays are very concerning.
‘Enable older people to get out of hospital’