Belfast Telegraph

Thursday 17 April 2014

18,988: the days wasted in our hospitals because healthy patients took up vital bed space

The extent of bed-blocking in Northern Ireland’s swamped hospitals can be revealed by the Belfast Telegraph.

Healthy patients spent a total of 18,988 days in hospital beds in the last year — despite being |declared well enough to leave.

That is the equivalent of a single bed being unavailable for a staggering 52 years.

In recent months hospitals have warned of unprecedented pressures on beds.

Earlier this week the Ulster Hospital said it was postponing around 30 operations a week because of a shortage of beds.

And last March a 77-year-old man died after he was left on a trolley at the Royal Victoria’s A&E, having waited 20 hours for a bed.

SDLP MLA Conall McDevitt, who sits on the Assembly’s health committee, said the statistics underlined the need for measures to be urgently introduced to address the situation.

The figures relate to the 12 months to April 2012 and were released following Freedom of Information requests to the five health trusts.

The Belfast Trust had the longest delays, some 5,973 days — equivalent to 16 years. However, unlike the other trusts, it only provided figures for complex |discharges, where patients require daily social services input after being released. Therefore, when non-complex delays are taken into account, the total is likely to be much higher.

The Western Trust, which includes Altnagelvin and the new South West hospital in Enniskillen, had delays totalling 5,454 days — almost 15 years.

Many of the patients affected across the five trusts are elderly.

Among the main reasons behind the delays are problems in arranging suitable aftercare, including the availability of nursing home beds, or where assessments have yet to be completed.

The average cost of a hospital bed in the UK is £250 per day — meaning the delays could result in a bill running into millions of pounds.

None of the trusts was able to provide the costs of delayed discharges. Mr McDevitt said the figures illustrated that more must be done to address patient flow in |hospitals.

“The figures unearthed by the Belfast Telegraph are staggering,” he said.

“Any reform in our healthcare system must prioritise patient flow to ensure there isn’t a management or process blockage.

“Unfortunately during the winter, when we see hospitals come under severe pressure, we begin to see where the real weakness is in the management of hospitals.

“These figures illustrate just how much work still has to be done to ensure bed-blocking becomes a thing of the past.”

However, Dr John Woods, chair of the BMA’s Northern Ireland consultant committee, said health trusts had made substantial progress in limiting the time patients spend in hospital during the last 10 years.

“Each patient should have a discharge plan appropriate to their needs and level of care,” he said.

“To avoid early re-admission it is important to get both the discharge and the support services right.”

What trusts say about the problem...

Northern trust: 2,492 days

What it said: “Whenever a patient is admitted to hospital, part of their initial care and treatment plan includes the commencement to work towards their discharge. Sometimes the complex needs of a patient means that the discharge planning process takes longer than the target set. It is important that patients are discharged safely with the appropriate level of support. The trust is committed to ensuring medically fit people are discharged in a timely manner. Of all discharges in the year 2011/12, only 3.19% were delayed.”

Western trust: 5,454 days

What it said: “The Western Trust continues to ensure that all patients are safely discharged in a timely manner. Trust staff are working hard to make sure no patient stays in hospital longer than is necessary and regrets that anyone experiences a delay in being discharged. It is important to note that for the same year, 47,254 patients were |discharged without any delay, which equates to 93% of hospital discharges. This number of patients experiencing a delay is less than the previous year and demonstrates the trust’s commitment to decreasing delayed discharges from hospital.”

Southern trust: 1,796 days

What it said: “The Southern Trust had 62,834 inpatient hospital admissions in 2011/12. The Department of Health target is that 90% of complex discharges from acute hospitals should take place within 48 hours and that all non-complex discharges take place within six hours. In the Southern Trust 93% of complex discharges take place in less than 48 hours and 95% of non-complex discharges take place in less than six hours.”

Belfast trust: 5,973 days

What it said: “We are now treating many more patients over the age of 65. A significant number will be in their 80s, 90s and above. When patients in these age groups are discharged as being medically fit they will continue to have nursing, personal care, mental health or therapy needs which need to be reassessed, planned for and provided for on discharge. However, all statistical evidence shows that the days calculated from being deemed medically fit for discharge to actual discharge have been falling significantly.”

South eastern trust: 3,273 days

What it said: “There has been a year-on-year significant increase in the number of sick patients requiring hospital care with most patients being elderly. There has been a significant reduction in the number of delayed days in the past five years. In respect of 2011/2012, the |delayed days represents 1.46% of all bed days. In 2011/12, 87% of all complex discharges were achieved without delay and only 5.6% of all complex discharges were delayed over seven days.”

How delays in discharging the medically fit created a growing crisis

Q What are delayed|discharges and why are they such a big issue?

A A delayed discharge — also known as bed-blocking — happens when a patient is |declared medically fit to leave hospital, but is not released. During 2011/12, healthy patients spent an additional 18,988 days in hospital after they were |declared fit to leave. If a patient is not released on time, they take up a bed which could be used by another patient waiting on treatment. There is already huge pressure on beds, with some hospitals forced to cancel operations because of a beds shortage.

Q So why are patients not |released on time?

A There are various reasons, but in most cases it is |because suitable aftercare cannot or has not been arranged. Many of the patients are elderly and nursing home beds may not be available. They may also require complex aftercare, which can take time to arrange. Some patients may also be waiting on transport, specialist equipment, pharmacy items, community support or visits by domiciliary care staff to be arranged.

Q What are the official guidelines for discharges?

A They fall into two categories — simple and complex. |Simple discharges, where a patient requires minimal aftercare, should be completed within six hours of a patient being declared fit to leave |hospital. Complex discharges, where a patient requires daily input from social services, should be completed within 48 hours. The Department of Health target is that 90% of complex discharges take place within 48 hours with all simple discharges done within six hours.

Q What are health trusts saying and doing about it?

A Each trust said its priority was to ensure that all patients were discharged safely and without spending longer in hospital than was absolutely necessary. All of them said that in most cases, patients were discharged within the required timeframe. For example, the Western Trust said 93% of its patients were discharged on time. The Trusts were also asked to provide the estimated costs of the delays, but were unable to do so.

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