Vital hospital bed space lost to patient discharge delays
INPATIENTS LEFT WAITING AN ADDITIONAL SIX DAYS TO BE SENT HOME AS PRIVATE FIRM IS BROUGHT IN TO HELP EASE THE BACKLOG
MEDICALLY-FIT Burton NHS patients are being cared for in hospital surgery beds for days instead of being sent home or to a care facility due to continued delays.
Hold-ups for hospital discharge have been a national theme across the NHS this year, and Burton is no different, due to a hamstrung health and social care system.
The Derby and Burton hospital trust, which oversees Queen’s Hospital, reports that more than 1,000 days worth of delayed bed days hamper its services every week.
It says blockages in the social care system are to blame, with patients medically fit for discharge typically sitting in hospital beds for an additional 5.7 days.
For comparison, this was an average of 4.5 days last year, even with Covid-19 pressures then at a higher level of concern.
At Royal Derby, in October, 545 discharge delays were said to have occurred in one week caused by “external” factors, while a remaining 200 delays were due to “internal” issues.
This, it says, has required the use of surgical elective beds, space meant for people who are in hospital for so-called optional surgeries such as hip replacements.
The hospital trust says it has now paid for a private agency to help support the early discharge of patients who no longer require care at Royal Derby, through private care facilities provided by Birmingham firm CHS Healthcare.
All of this is happening while the hospital trust and rest of the healthcare system prepare for winter and continue to battle an unprecedented waiting list backlog – while staff turnover and vacancies grow.
Issues like discharge, like everything also in the healthcare system, do not exist in a vacuum and are impacted by a number of factors.
For example, higher pressure on emergency departments such as Royal Derby’s A&E lead to more strain on the “front door” leading to more of a push to get as many people out of health services.
In October, around 3,300 people a week were arriving at the University Hospitals of Derby and Burton NHS Foundation Trust’s A&ES. Of these, around 1,400 were admitted.
Many people arriving at A&E and those admitted to hospital are being seen to present at hospital with more progressed conditions due to issues they may have delayed during lockdown. This can lead to patients staying in hospital for longer periods of time – meaning fewer are leaving to free up space.
In Derby, at the tail end of October, around 140 patients were occupying beds for more than 21 days, up from 80-120 through September, but a reduction from 140 to 165 through July.
Increased strain at emergency departments also leads to longer waits, with Royal Derby A&E patients taking an average of five hours to be seen and not admitted – above a national target of three hours.
Royal Derby A&E patients are taking an average of 8.5 hours to be seen and admitted into care, above a national target of five hours.
For further context, there is a national target to have no more than two per cent of A&E patients waiting for 12 hours or more to be seen and admitted, with Royal Derby recording 11.7 per cent of patients waiting for 12 hours or more.
This is more than one in every 10 patients and in excess of five times the target amount. Delays in getting patients from ambulances into hospital are also being hampered by under-pressure A&ES and backed up discharge processes.
In September, the most recent data, 617 ambulances waited for more than 30 minutes before a patient could be handed over to a hospital, leaving it unable to respond to other incidents, while 242 ambulances waited over an hour.
The trust says this “compromises safety in our community by reducing the availability of ambulances to respond to emergencies”.
Stephen Posey, new chief executive of the trust, details in board papers the organisation is continuing to do all it can to handle the pressures.
Mr Posey wrote: “Our people continue to put all their efforts into putting patients first and we are making changes to how we operate to make sure we are prepared for what is going to be a challenging winter.
“This includes reconfiguring our assessment space at Royal Derby Hospital, opening new discharge to assess beds through the Integrated Care Boards in Derbyshire and Staffordshire, and working with East Midlands Ambulance Service to trial some work on reducing ambulance handover delays.
“Covid-19 continues to create operational pressures and, at the time of writing this report (early November), the trust was caring for 160 patients who had tested positive.
“Winter this year comes off the back of an extremely busy summer with high demand for emergency care, an ambitious elective recovery programme, rising Covid inpatient numbers and related staff absence due to isolation rules.
“Capacity challenges across Derbyshire and Staffordshire have resulted in discharge delays which restricts flow through our hospitals and creates additional pressure inside our A&E departments.”
He reiterates advice from the Derbyshire healthcare system stating that urgent treatment centres in Derbyshire and Staffordshire “will always treat a minor illness or injury quicker than a busy A&E”.
John Macdonald, chairman of the Derby and Derbyshire Integrated Care Board (ICB), which oversees the county and city’s health and social care system, said: “Our system continues to see ambulances waiting longer than desired at our accident and emergency departments.
“This is in part due to the challenges faced in discharging patients with a suitable care package once their hospital treatment is complete, creating a problem with the flow of patients through our services.
“Our teams are working very hard to improve our performance in the face of these challenges, but we are sorry for these delays as this is not optimal care for our patients.” The ICB’S winter plan details that the Derbyshire system is short of 460 packages for home social care support outside of hospital every month, and short of 45 step-down nursing beds for rehabilitation.
It says 36 hours of “productive paramedic time” is being lost every day due to ambulance delays.
As a result of widespread pressures, 23 extra beds are being opened at Florence Nightingale Community Hospital in Derby, Derbyshire County Council is freeing up 10 “interim” beds, and Ashgate Hospice is setting four extra beds, while CHS Healthcare (a private firm) is providing the clinical support necessary to staff 14 beds at Ilkeston Hospital, alongside 200 “virtual beds”. The ICB is also looking for a 10 per cent increase in on-the-day GP appointment capacity.
Staffordshire health officials urge patients to visit urgent treatment centres for issues which are not lifethreatening; make use of the mental health helpline via 0800 028 0077; make appropriate use of the NHS111 service for advice and medical support; and seek help from your local GP.
Capacity challenges have resulted in discharge delays which restricts flow through our hospitals. Stephen Posey