The NHS in England will again struggle to cope with demand this winter without more beds and funding, according to a new analysis.
Researchers from the Nuffield Trust say that last winter just 3.6 per cent of patients - the majority of whom were elderly and frail - took up more than a third of hospital beds because they spent longer periods in hospital and were readmitted more regularly than other patient groups.
According to the research group, if additional resources were directed at helping this particular demographic, it could have a large impact on how effectively hospitals cope this winter.
The NHS has struggled with a succession of winter crises particularly in Accident and Emergency departments. In 2013/14, £250m of additional funding failed to relieve the pressures of the expected winter demand, while in 2014/15 an extra £750m failed to prevent a catalogue of hospital ‘black alerts’ and the worst waiting times in a decade.
This winter, the health service has limited extra money to hand and faces the greatest financial strain for generations. NHS performance data for September shows that hospitals in England missed key targets for cancer care, A&E waiting times, ambulance response times and diagnostic tests. The figures show that hospitals in Wales, Scotland and Northern Ireland are also struggling to cope with demand.
What Can be Done to Ease the Pressure?
The Nuffield Trust analysis suggests an extra 14,000 beds would be needed to ensure hospitals achieve the 85 per cent bed occupancy rate recommended by experts. This, they admit, is simply not possible.
Research suggests that when bed occupancy rates exceed 85 per cent it can affect the quality of patient care provided and push hospitals towards breaching the four-hour A&E target of patients either being admitted or sent elsewhere upon arriving at emergency departments.
Instead, researchers say money should be directed in a more strategic way, namely, by focusing on the small number of patients who account for the highest bed occupancy during the winter months.
Their analysis highlights the cuts on council budgets that have so severely hampered social care services, which are seen as critical for keeping elderly people out of hospital and ensuring that if they are admitted, they can be discharged as soon as they are well enough.
According to the study, reducing the amount of time frail and vulnerable patients spend in hospital could have a disproportionate impact upon managing ward capacity. Careful monitoring of the quality of care this group receive would also help prevent overcrowding, discharge delays and repeated readmissions.
Intermediate Care Beds
The report suggested allowing hospitals to discharge the most vulnerable patients into safe environments until they recover fully. Temporary or permanent places can be found in care homes, or care packages can be arranged in their own homes. This is referred to in the report as the provision of “intermediate care beds”.
Research has shown that patients in these age groups fare much better in environments such as their own homes, or in special housing or nursing homes, rather than hospitals, especially if they are supported by community nurses.
Despite record additional NHS funding last winter, too many Trusts struggled to meet the four-hour A&E target, mainly because so many beds were occupied with frail and elderly patients. Intermediate care beds could be an effective solution to get these patients out of hospital and free up beds to help hospitals cope this winter, providing of course that they are well enough to be discharged and that the discharge process is carried out with dignity and compassion.
Unfortunately, it has become entirely normal and indeed expected to hear about hospitals declaring black alerts and A&E departments buckling under pressures to deal with record admissions during winter. So far this winter we have not seen the same black alert headlines - a reassuring sign that things may have improved.
A recent study by the Strategic Society Centre estimates that up to 1.4m elderly people “who struggle to look after themselves do not receive community support.” In order to avert yet another winter beds crisis, the NHS needs to perhaps look at preserving levels of social care funding to ease the pressure hospital trusts continue to face every winter.
Gill Edwards is a clinical negligence solicitor at Slater and Gordon in Manchester.
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