The NHS is facing a crisis: billions wasted on unnecessary hospital stays. But why? Last week, ambulances lined up outside the Royal Berkshire Hospital in Reading, with patients overflowing into corridors, awaiting ward beds. Dr. Omar Nafousi, an emergency department consultant, expressed his frustration, stating that this wasn't the medical career he envisioned.
Winter viruses and cold weather exacerbate the strain on the NHS, with nearly 4,000 beds in England occupied by flu, COVID, and norovirus patients. But an even more significant issue looms: patients who don't need hospital care.
NHS England data reveals over 13,000 patients in England and 4,000 in the rest of the UK remain in hospitals post-treatment, occupying one in eight beds. These 'delayed discharge' patients are often elderly, frail, and managing multiple health conditions, requiring community support.
The financial implications are staggering. Each hospital bed costs £562 daily, resulting in a monthly loss of over £225 million for the NHS in England alone. This situation also impacts other patients, leading to canceled surgeries and long waits in A&E due to bed shortages.
Healthcare professionals are feeling the strain. Laura Hichens, a nurse leading the discharge liaison team at Queen Elizabeth Hospital in Gateshead, shares her distress at seeing patients deteriorate in hospitals when they could thrive elsewhere.
The delayed discharge issue isn't new. It's been a topic of discussion for years, with the NHS tracking delays since the early 2010s. Last summer, the government launched an urgent care plan to reduce these delays, but the problem persists.
Solving this issue could revolutionize the NHS, but it raises deeper questions about the care system, coordination, and planning. Some doctors question whether the NHS is over-treating patients, especially those nearing the end of life.
Discharging patients seems straightforward, but it's complex. Emma Dodsworth, a researcher at the Nuffield Trust think tank, explains that it requires time and effort, often involving home adaptations, short-term care, or care home placements. With an aging and frailer population, the system struggles to keep up.
Effective discharge planning relies on collaboration between council-run social care services and the NHS. At Queen Elizabeth Hospital in Gateshead, social workers and nurses work together in a discharge liaison hub, alongside a housing officer who arranges home adaptations and temporary housing. This approach has significantly reduced delayed discharges.
However, a recent report by the NHS Confederation and the Association of Directors of Social Services (ADASS) highlights inconsistent cooperation between the NHS and social care sectors, with relationships sometimes becoming strained.
Kerrie Allward, policy lead for ADASS and executive director for adult social care and health at Walsall Council, attributes these challenges to funding issues. Local authorities spend around £32 billion annually on adult social care, but rising costs, increasing demand, and more complex needs have outpaced this investment.
Some councils have increased social care spending, but many lack the funds for integrated services that could expedite discharges. Allward notes that while she values her collaboration with the NHS, not all social care directors share this positive experience, with some NHS leaders blaming social care for delays.
The government plans to increase investment in social care and reform funding, but the situation remains challenging. Other European countries, like Denmark, have adopted different approaches, creating a national network of intermediate care beds in community hospitals and care homes, staffed by nurses and carers, for post-discharge patient care.
Denmark has also invested in community nursing services, supporting patients in their homes instead of hospitals. Emma Dodsworth suggests learning from Denmark's integration of health and social care.
Some NHS trusts have purchased care home places for patient discharge, with University Leicester Hospitals NHS Trust going further by investing £10 million in Preston Lodge, a former care home with over 50 beds. Staffed by nurses, physiotherapists, and occupational therapists, Preston Lodge provides ongoing support for medically fit patients, reducing their hospital stay by an average of 10 days.
Preston Lodge offers a homely environment, with patients sharing meals and socializing. Emma Roberts, the trust's head of nursing, emphasizes that hospitals are ideal for acute care but not for long-term stays.
Emma Dodsworth advocates for more 'step-down' facilities like Preston Lodge to support patients' recovery without occupying hospital beds. However, the lack of integration between social care and the NHS hinders the widespread adoption of this approach.
Improving NHS-council coordination is crucial, but it's not the only solution. NHS England data shows that only a third of delays are due to community care or care home availability. Family attitudes also play a role, with some preferring hospital care for their loved ones.
Nurses like Laura Hichens spend considerable time convincing families that their relatives would be happier and healthier elsewhere. Dr. Vicky Price, an acute medical consultant, notes that some families are unwilling or unable to take on caring responsibilities, which is more common in cultures without care homes.
Price also highlights the medical profession's role in this issue, stating that about a third of medically admitted patients are in their last year of life. These patients often receive excessive treatment, scans, and medication, which can lead to adverse side effects and worsen their health.
Doctors may lack the confidence and time to have difficult conversations with families about end-of-life care. Palliative care and symptom management could improve patients' quality of life and reduce hospital admissions, but there are barriers to accessing these services.
The Association of Palliative Medicine argues that insufficient investment in end-of-life care leaves many without support. Clifford Kilgore, a senior nurse, emphasizes that reducing hospital admissions is crucial, as older patients with acute illnesses can become immobile and dependent after prolonged hospital stays.
Kilgore helps run a 'hospital-at-home' service, providing specialist care to frail patients with conditions like heart failure and respiratory illness. While these services care for around 12,000 people nationwide, they are not universally available. Expanding expert care outside hospitals is a priority in the government's 10-year NHS plan.
Kilgore believes this approach could have an immediate impact, but it's not fast enough for patients like those in Reading, waiting for a hospital bed. The NHS crisis demands urgent attention, and the solutions are complex, requiring collaboration and innovation in healthcare and social care.
