Delays in discharging patients adds pressure on hospitals amid coronavirus second wave

Shaun Lintern
·6-min read
Hospitals have warned of significant delays in discharging patients as Covid cases keep rising (Getty/iStockphoto)
Hospitals have warned of significant delays in discharging patients as Covid cases keep rising (Getty/iStockphoto)

Delays in discharging patients from hospitals is making pressure on the NHS from the second wave of coronavirus worse, hospital chiefs have warned.

Some hospitals are already reporting almost all of their beds are full with patients as the number of coronavirus cases continues to surge with more patients needing hospital care every day.

Doctors have told The Independent the lack of discharges means fewer beds are free and some hospitals are seeing long waits in A&E for beds to become available.

NHS Providers chief executive Chris Hopson said: “Some of our chief executives are saying they are seeing bed occupancy levels of 92, 93, 94 per cent at the end of October when they would normally expect these to be 86, 87, 88 per cent.

“Given where we are in terms of the winter cycle, and the fact we are not really at the beginning of winter yet, that is a worry.

“There are much higher bed occupancy levels now than you would normally expect to see at this time of the year.”

Without enough spare beds, hospitals will not be able to go ahead with planned surgeries and will have to make patients wait longer for a bed in accident and emergency departments.

One senior nurse in the northeast said her hospital had seen more than 100 medically fit patients ready to be discharged earlier this month although the numbers have since fallen to around 60 last week.

She added: “It is crazy as you have a queue in A&E and you’ve got no flow, and bays closing due to Covid yet loads of beds full with people that don’t need to be there.

“They’re sitting ducks for catching Covid too.”

In the northwest region, which has seen the highest levels of infection in recent weeks, one senior doctor said delayed patients were catching coronavirus while waiting on wards adding care homes did not have the staff or the space to handle Covid positive patients.”

The delays could hamper hospitals’ ability to maintain routine surgery if there is a lack of free beds. Hospitals across the north of England as well as in Birmingham and Nottingham have been forced to cancel operations.

During first wave of the pandemic, a new discharge to assess model was put in place that saw thousands of patients discharged in March to help release 15,000 beds ahead of the coronavirus peak.

Under the model, which has been extended to 21 March, the NHS will cover the costs of any patient who needs support either in their own home or in a care home for the first six weeks of their care. The government has provided £588m of funding.

But Mr Hopson said some local councils were “nervous” about committing funds in the longer term because of wider financial pressures on social care.

“There is definitely concern among some of our members that discharge flow is slowing down. This means a number of medically fit patients who earlier in the year would have been discharged now can’t be.  

“Local health and care systems did a brilliant job in the first phase of speeding up the discharge of patients from hospitals. What we are hearing now is that there is nervousness among local councils about whether or not the funding for the care packages needed to ensure prompt discharge from hospital will actually arrive and is guaranteed. So they are nervous about committing to the money involved.

“Given the huge pressure local authorities are under, that’s not a surprise, but it’s a real worry. The government needs to think quickly about what more it can do to give local authorities greater certainty here.”

Martin Green, chief executive of Care England, blamed a failure of government saying: “This is supposed to be a national emergency. Why isn’t the government taking the lead on this. It is incredible.”

He argued that failing to set a national tariff on discharges meant each local council was making its own decisions on funding longer term care packages, resulting in variation across the country.

“We have got reduced capacity in care homes, we have the capacity to take more people. The reason for the delays is the government is so wedded to the idea of localism. Local authorities can do what they like, it’s a real failure and the government being gutless about doing anything from the centre.”

Council leaders say a national tariff would ignore variation in local cost of living and that the largest problem is not the willingness of councils to fund care packages but the lack of capacity to meet the volume of demand for care and insufficient overall funding in the system.

Julie Ogley, immediate past president of the Association of Directors of Adult Social Services, said: "The rise in coronavirus infection rates is having significant impacts on older and disabled people and their needs for care, treatment and support across the board, at home as well as in hospital. 

"New hospital discharge arrangements mean that, whilst the vast majority of people will leave hospital with no further care and support needs, the NHS will pay for care and support for up to six weeks [at home or in care homes] so that people’s needs can be assessed, they can receive rehabilitation and, if they need longer term care, their future plans can be discussed and put in place.

“Only a tiny proportion of people will need residential care and the principle we work to is to support people to get home first. Whilst recruiting and retaining staff is a challenge, and sometimes there are delays from hospitals in relation to medication, transport and test results, they are rapidly speeding discharge, albeit presenting increased pressures in the community.”

Last week, the Commons health committee called for a £7bn annual increase in funding for social care.

An NHS England spokesperson said: “Long stays in hospitals have actually been reduced and are lower than pre-pandemic levels but hospitals are obviously continuing to see an increase in demand due to coronavirus, at the same time as trying to maintain essential services for treatments like cancer and elective surgery for patients with other conditions.

“The government has given health and social care £588m to fund new packages of care for up to six weeks post discharge, with each area putting in place arrangements that work best for their communities.”

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