Health chiefs fear meltdown over bedblocking

Bed-blocking is at its worst ever level. Picture: Getty

Crippling levels of bed blocking – where patients cannot leave hospital because there is no other care in place – have left NHS Lothian “teetering on the edge”. With hospitals already full, worried health bosses are questioning how they will cope this winter, especially as the vomiting bug norovirus has arrived early.

Three additional wards, usually reserved for a seasonal surge in patients, have already been opened along with dozens of “step-down beds”, where patients can be temporarily put in care home settings to continue recuperation.

The crisis has also forced more than 300 operations to be cancelled due to lack of recovery room, frustrating patients and leaving surgical staff in limbo.

Despite introducing a raft of measures with councils to alleviate the strain, NHS Lothian confessed it was struggling to cope with the hundreds currently trapped in the system.

Melanie Johnson, executive director of nursing and unscheduled care, said patients both in and out of hospital were being left at “significant risk” by the highest level of bed blocking ever recorded.

She told the NHS Lothian board there would be no let-up when it came to admissions, with cases of norovirus already being treated. “We like to think that winter starts in January but last year we had very significant pressures in late October,” she said. “Norovirus is already with us so I am feeling particularly concerned about the position and I am not reassured that we have everything yet in place to see us through January and February in terms of the potential demands on acute services.”

The rise – culminating in 434 people currently confined to the regions’ hospitals compared with 133 this time last year – is being blamed on a soaring ageing population and a shortage of care home beds.

Fewer than half of the care homes in Edinburgh will accept patients at the national rate of £580 per week, with some care homes charging more than a £4000 a month.

The recent closure of the scandal-hit Pentland Hill Care Home lost 120 beds and a further eight care homes in the Capital were closed to new admissions over concerns from the Care Commission.

Council and health bosses have put multi-million pound plans in place in a bid to ease the strain, including recruiting more care staff and increasing the hourly rates paid to firms providing care.

But so far, the measures have done little to alleviate the issue – which has seen the number of days lost to bed blocking increase by 69 per cent in just 12 months.

People delayed in hospital ran the risk of losing their independence and institutionalisation, as well as increased chances of catching an infection or having a fall, Ms Johnson warned. Waiting times have also suffered with the number of four, eight and 12-hour breaches on the up.

She added: “There is also an enormous amount of clinical and managerial time being spent on trying to deal with the issues of the patients who are delayed and helping others through the system.”

The situation has caused considerable concern amongst patient groups and politicians. with calls for a radical overhaul of the care system for the elderly.

Dr Jean Turner, executive director of the Scotland Patients Association, said what was once a seasonal problem has become a permanent fixture.

She said: “They haven’t solved what used to be a winter problem and it has now become an all-year problem.

“I think it is appalling and a great tragedy that we’ve created a situation where there’s no adequate care for people to leave hospital.

“We have known for ages that people are living longer with more complex conditions and it is shameful that we haven’t addressed this problem.”

Lothians Labour MSP Sarah Boyack, who has previously raised the issue in parliament, said the pressures will only increase without more funding from the Scottish Government. She said: “I’m concerned that our hard-pressed NHS services are teetering on the edge. To be dependent on a warm winter and an absence of norovirus is totally unacceptable.

“I’ve raised the issue of the systemic underfunding of NHS Lothian before and my worries about the lack of capacity and funding to meet existing pressures in the system.”

A summit was recently called with experts from across health and social care service from the local authorities in attendance to deal with the “unprecedented and unsustainable” situation.

City council health leader Ricky Henderson, who is in regular meetings with NHS bosses in a bid to cope with the spiralling demand, said care-at-home provision had also been increased to record levels, up 17 per cent in 18 months.

Professor Alex McMahon, NHS Lothian director of strategic planning, said a new plan was already in place which will be regularly reviewed.

He said: “The aim was to develop new ways of addressing the issues to ensure patients do not have to remain in hospital once their treatment is complete and reducing the knock-on effects and consequences for other parts of the service.

“As part of the plan, we intend to provide better support to people at home to prevent hospital admissions, review respite services and release more capacity by providing repeat outpatient follow-up appointments.”

ANALYSIS

By Brian Sloan, Chief executive officer of Age Scotland

OLDER people remain dispropor-tionately at risk of remaining in hospital far longer than is absolutely necessary.

The greatest contributor to the problem is the lack of appropriate services within the community which would otherwise enable patients to return home or move on to a care home.

There needs to be radical change in how we deliver services if we are to respond to the needs of our ageing population. Far greater investment is required in local networks of community care providers – incorporating key partnerships such as the third sector and social enterprises – to help bring an end to the practice of bed-blocking.

Planning for a good discharge should start almost the moment that a patient enters hospital, and requires professionals to work across boundaries. It is to be hoped that, as we move forward with the integration of health and social care this is something which will improve and that health, social care and the third sector can work more collaboratively to provide truly person-centred discharge planning and pathways for onward care.

Some delayed discharges can happen because the patient no longer has the capacity to make decisions about their care, and they haven’t made a Power of Attorney to give someone else the legal right to make these choices for them. This is why Age Scotland is currently running an information campaign to make people aware of Power of Attorney.

Information on this Power of Attorney campaign can be found at www.agescotland.

org.uk/poa.