NHS bed shortage now more severe than at any time in pandemic
THE Welsh NHS is currently dealing with a bed shortage crisis more severe than at any other point in the pandemic.
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 hospital-acquired 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’s 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’s 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 and the resumption of routine and elective NHS care in an attempt to clear the record-breaking 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.
“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.
“NHS Wales is seeing an increase in patients requiring urgent care for non-covid-19 issues and levels of those seeking help is above that seen pre-pandemic.
“There are still significant numbers of patients being cared for in hospitals with Covid-19-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.
“Consequently, these factors will put the NHS, its nurses and health workers under increased pressure this winter. Not only due to the increased cases of winter-related health issues but also the number of vacancies we are seeing within the workforce who are exhausted and burnt out.”
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 medically fit to be discharged from hospitals but still awaiting a health or social care package in the community.
“Despite many hospitals seeing reduced admissions directly from the pandemic, 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. We will continue to keep up high levels of PPE, social distancing and ventilation for the foreseeable future.”
Last week Health Minister Eluned Morgan said she was “really, really fearful” that the pressure could overwhelm the NHS this winter and has not ruled out reintroducing restrictions. She said the public also had a responsibility to take the pressure off the NHS by only using services when necessary and having their Covid and flu vaccinations.