Concern rises at NHS bed ‘crisis’
THE Welsh NHS is currently dealing with a bed shortage crisis more severe than at any other point in the pandemic, it has been revealed.
Latest figures from the Welsh Government show that out of the 9,421 beds available in general and acute settings on November 11, just 925 (9.8%) of them were vacant (ie. not occupied by a patient).
To put this into context, at the height of the first wave of Covid infections there were 3,122 (50%) vacant beds out of 6,259 on April 11, 2020, and during the second wave there were 1,468 (16%) vacant beds out of 9,281 on January 11, 2021.
It’s a similar story for invasive ventilated beds which are typically given to the most seriously unwell patients in intensive care.
On November 11 there were just 36 vacant beds of this type in the entire Welsh NHS, which is far lower than the 192 vacant on April 11, 2020, but on a similar level to January 11, 2021 (37).
In some health boards, including Aneurin Bevan (three vacant), Cwm Taf Morgannwg (four), and Hywel Dda (five), intensive care staff are perilously close to running out of invasive ventilated beds ahead of the notoriously busy winter period.
High hospital bed occupancy rates are seen as an important indicator of a health system under pressure as it leads to delays in A&E, patients being placed on clinically-inappropriate wards and a rise in hospitalacquired infections. Bed availability is also closely linked to staffing as beds cannot be safely filled without appropriate clinicians on duty.
Evidence shows that hospitals work most safely and effectively at bed occupancy levels no higher than 85%. However, figures show that all of Wales’ health boards have a higher rate including Cardiff and Vale (85.7%), Aneurin Bevan (86.1%), Betsi Cadwaladr (90.3%), Swansea Bay (91.7%), Hywel Dda (94.3%) and Cwm Taf Morgannwg (96%).
Dr Suresh Pillai, vice-president of the Royal College of Emergency Medicine (RCEM), said these high bed occupancy rates across Wales’ hospitals were
“unsafe for patients and highly stressful for staff”.
“If there is a surge in attendances, which is highly likely as we descend into the colder months, health boards in Wales may struggle to cope. To reach safe occupancy levels in Wales (85% occupancy) there needs to be an expansion of 550 staffed beds,” he said.
“Given current workforce shortages and the need for safe infection prevention and control measures, achieving this in the short-term may be a challenge. But with patient safety at imminent risk, the Welsh Government must ensure that health boards have the ability to safely expand capacity now.
“The urgent and emergency care system in Wales faces a crisis and creating surge capacity is crucial to reducing ambulance handover delays and dangerous crowding that leads to avoidable harm.
“In the longer term, RCEM estimates that there is a shortfall of 100 emergency medicine consultants in Wales. To expand capacity in a sustainable manner there must be significant growth in workforce numbers.”
Experts warn that the dual problem of high Covid infection rates, which continue to hover above 500 cases per 100,000 population in Wales, and the resumption of routine and elective NHS care – in an attempt to clear the recordbreaking backlog – are leading to a rise in bed occupancy levels.
Dr Olwen Williams, vice-president for Wales at the Royal College of Physicians (RCP), said the main issue was around the NHS’s ability to staff more beds.
“It’s simple really: workforce, workforce, workforce. The main reason we are struggling with waiting lists and the backlog is that we don’t have enough staff to cope,” she said.
“There aren’t enough doctors and nurses in the Welsh NHS, and those that are left are exhausted and demoralised. Morale is low. I don’t know how we’re going to get through the winter to be honest.
“To cope with the expected increase in patient demand over the next decade, we need to be creating an additional 350 medical school places every year in
Wales – almost double the number of places available now. Phased in over five years, this equates to an extra 70 spaces every year for the next five years. However, in September, 2020, we saw only 25 new spaces created at Cardiff University, and in September, 2021, only 12 spaces.
“An ageing population with long-term illness, growing obesity, advances in genomics and new technologies will all mean increased demand for doctors. Hospital activity – both emergency and elective – is steadily rising, and the backlog is not getting any smaller. It’s an incredibly difficult time to be working in medicine.”
Nicky Hughes, associate director employment relations at the Royal College of Nursing (RCN) in Wales said there were a number of “interrelated issues” contributing to the number of available hospital beds across health boards in Wales.
“Heath and social care are currently seeing unprecedented demand which is stretching services to the limit,” she said.
“NHS Wales is seeing an increase in patients requiring urgent care for nonCovid-19 issues and levels of those seeking help is above that seen pre-pandemic. Covid has far from slowed down, with case numbers still high and circulating in communities.
“The vaccination programme has had a positive effect on the seriousness of the illness when contracted, however, there are still significant numbers of patients being cared for in hospitals with Covid19 related issues. This is with the backdrop of health boards increasing routine services to reduce the waiting times for patients who were unable to access care during the pandemic.
Dr Phil Banfield, chairman of the British Medical Association’s (BMA) Welsh Consultants Committee, said one of the major factors impacting vacant beds was the number of patients who were medically fit to be discharged from hospitals but were still awaiting a health or social care package in the community.
“Despite many hospitals currently seeing reduced admissions directly from the pandemic, which is partly due to public health measures to reduce Covid19 transmissions, these figures remain extremely concerning,” he admitted.
“This puts more pressure on the whole system as patients are already using facilities we will need when there are additional spikes in admissions each winter, and it also leads to long delays as patients arrive at emergency departments.
“We know that as bed occupancy rates increase, so too do the levels of hospital acquired infections, and it is likely that Covid-19 will be no exception. However, we will continue keep up high levels of PPE, social distancing and ventilation for the foreseeable future.”
Commenting on the bed vacancy rates, a Welsh Government spokesperson said: “The NHS is facing unprecedented pressures as we move into winter, from people with Covid and other winter illnesses, emergency pressures and the need to provide care and treatment postponed earlier during the pandemic.
“We have provided more than £300m extra funding this year to tackle waiting times, improve emergency care and social services. This money will help deal with these pressures over the winter and to transform the way services are delivered in the future.
“Everyone can play their part this winter by considering other options for care, like the 111 online service and pharmacies.”