The NHS is in a crisis, with billions wasted on unnecessary hospital stays. But why is this happening, and what can be done to fix it?
The Vicious Cycle:
Ambulances line up outside hospitals, while inside, corridors are filled with patients awaiting beds. This is the reality for many hospitals across the country, as winter illnesses and cold weather exacerbate the strain on the NHS. But the real issue lies with patients who don't even need to be there.
The Overlooked Problem:
According to NHS England, nearly 4,000 beds in England are occupied by patients with flu, COVID-19, and norovirus. However, this pales in comparison to the number of patients who should have been discharged but remain in hospital. Over 13,000 people in England and 4,000 in the rest of the UK are in this situation, meaning one in eight beds are occupied unnecessarily.
These patients, often older and frail with multiple health conditions, require community support. But keeping them in hospital comes at a staggering cost. Each hospital bed costs £562 per day to staff and maintain, resulting in a monthly loss of over £225 million for the NHS in England alone.
The Impact on Patients and Staff:
The consequences of this issue are far-reaching. Clifford Kilgore, a senior nurse working with older people, highlights the cancellation of surgeries and long waits in A&E due to bed shortages. For staff, it's demoralizing. Laura Hichens, a nurse at Queen Elizabeth Hospital, describes the distress of seeing patients deteriorate in hospital when they could be better off elsewhere.
A Long-Standing Issue:
Delayed discharges have been a topic of discussion for years, and the NHS began tracking these delays in the early 2010s. Last summer, the government's urgent and emergency care plan promised to reduce these delays. Experts believe solving this problem could significantly improve the NHS.
Deeper Questions About the Care System:
However, the issue raises deeper questions about the care system, coordination, and planning in hospitals. Some doctors even question whether the NHS is over-treating patients, especially those nearing the end of life. The system seems to be running faster just to maintain the status quo.
The Complexities of Discharge:
Discharging patients is not as simple as it seems. Emma Dodsworth, a researcher at the Nuffield Trust think tank, explains that it requires significant time and effort. Patients may need home adaptations, short-term help with daily tasks, or regular nurse visits. Some require a combination of these, while others need a care home place.
The Importance of Collaboration:
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 employed by the council. This approach has been successful in reducing delayed discharges.
Strained Relationships:
Despite these examples, a recent report by the NHS Confederation and Association of Directors of Social Services (ADASS) reveals inconsistent cooperation between the NHS and social care sectors across the country, with relationships sometimes becoming strained. Kerrie Allward from ADASS attributes this to funding issues, as local government funding cuts have impacted social care spending.
The Role of Family Responsibility:
Improving coordination between the NHS and councils is crucial, but it's not the only solution. NHS England data shows that only a third of delays are due to a lack of community care or care home places. Another factor is the preference of some families to keep their loved ones in hospital, believing it's safer.
Nurses like Laura Hichens spend time convincing families that their relatives would be happier and healthier elsewhere. However, some families are unwilling or unable to take on caring responsibilities, which can be financially challenging. In other cultures, families step in, reducing the need for care homes.
Rethinking End-of-Life Care:
Dr. Vicky Price, an acute medical consultant, believes the medical profession also bears some responsibility. She argues that about a third of patients admitted for medical reasons are in their last year of life and often receive excessive treatment. Changing this approach raises ethical questions, as palliative care and symptom management may be preferable for many patients, improving their quality of life and avoiding hospital admissions.
The Way Forward:
The Association of Palliative Medicine advocates for increased investment in end-of-life care, as many people struggle to access support. Reducing hospital admissions is crucial, and the NHS's 10-year plan prioritizes providing more expert care outside hospitals. Services like 'hospital-at-home' care for frail patients with conditions like heart failure and respiratory illness are part of the solution. But will these measures be enough to break the vicious cycle and ensure timely discharges for all patients?
