Social care crisis leaves thousands stuck in hospital beds

NHS crisis: Dr Hilary Jones reads out messages from doctors

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Professor Adam Gordon, president of the British Geriatrics Society, said the majority were older patients living with frailty or long-term health problems.

He told the Daily Express: “Increasingly we find that when people are medically stable for discharge there’s limited rehabilitation capacity in the community for those needing therapy, and less capacity in care homes and with domiciliary care packages.

“So they have to remain in hospital until a safe discharge plan can be put in place.”

More than one in ten NHS beds in England is occupied by patients who no longer need hospital care.

Although not the only issue the NHS faces, it is a core problem that leaves the seriously ill waiting for hours to get a bed and ambulances backed up in hospital car parks because casualty wards cannot accept more patients.

The number remaining on wards unnecessarily peaked at over 14,000 in mid-December.

Hospitals were told by NHS chiefs to safely discharge as many people as possible ahead of a strike by ambulance staff on December 21.

NHS data shows that on Christmas day, 17,216 patients “no longer met the criteria to reside” and 5,421 were discharged.

This meant 11,795 stayed on wards – 68 per cent of the total. The figure was up from 9,213 on Christmas Day in 2021.

Prof Gordon said the delays were putting frail elderly patients at greater risk of harm.

He said: “We know that periods of prolonged bed rest are associated with increased weakness, difficulty walking, risk of falls and risk of hospital-acquired infections.

“Once people have been designated as being medically stable for discharge, the best place for them to be is in the community.”

Older people are also more likely to stay in hospital after visiting A&E, and to deteriorate while waiting for a bed, Prof Gordon said.

He added: “I don’t think there are any quick fixes here. There has been a social care staffing crisis ever since the pandemic.

“Most social care staff work for the minimum wage, or just above, and there’s work they can do that is less emotionally and physically demanding in other sectors that pays better.

“If we’re going to start to reverse the trend we need to get both local and national government to look at what rates they are able and prepared to pay for social care.”

The Government created a £500 million discharge fund to bolster social care this winter.

But Sheila Norris, chief executive of the Association of Directors of Adult Social Services, said investment was needed across home and community services, growing the workforce and support for family carers.

She warned the sector was facing a staffing crisis with 165,000 vacancies.

Ms Norris said: “The national conversation remains almost exclusively concerned with resources for acute hospitals and issues relating to hospital discharge.

“Whilst the Government’s £500m winter funding provides welcome relief, it is targeted at hospital discharge rather than the sustainable care and support that could prevent people from being hospitalised in the first place.”

Sally Warren, director of policy at The King’s Fund think tank said access to community services could make a huge difference both before and after a patient is admitted to hospital.

She told BBC Radio 4’s Today programme: “We’ve got tens of thousands of people waiting for a social care assessment. While they’re waiting their condition might deteriorate and they may end up in the NHS system, be that with their GP, with NHS 101, or at the hospital front door.

“Then, once people are in hospital, you need to be starting to plan their discharge almost as soon as they’ve been admitted to hospital.

“A lack of capacity and social care can be a real barrier to how quickly people can be discharged back to their preferred place again, be that their home or a care home.”

The bed-blocking crisis means hospitals across the country are struggling to find space for those arriving through the doors of A&E.

In November, around 38,000 people waited for more than 12 hours in A&E for a bed to become available after a decision to admit them.

Richard Webber, spokesperson for the College of Paramedics, said a recent shift was one of the worst in his 10-year career.

He said: “One day last week I ended up taking a patient to hospital who was in his 90s. He had an internal bleed and needed care.

“He was taken off the ambulance, put in the department, assessed, then put back in my ambulance to wait for a bed. I spent five and a half hours with this gentleman in the back of my ambulance.”

Eight other crews were waiting to handover patients who were all aged over 70, Mr Webber said.

The waits sometimes mean there are no ambulances available to respond to calls – even cardiac arrests – and patients are deteriorating or dying before help arrives, he said.

He added: “I’ve talked to colleagues who work in acute hospitals and they are full of patients who should be elsewhere. Many hospitals have 100 or 200 patients who shouldn’t be in the hospital.

“It seems to me completely bizarre that a patient who has been deemed by a consultant as medically fit to go home, or to somewhere else for care, is left in a bed while somebody who is not medically fit sits outside in an ambulance for eight to ten hours waiting to be admitted.”

The London Ambulance service has said it will only spend 45 minutes handing patients over at A&Es.

A leaked email seen by ITV said clinically stable patients would be left on a hospital trolley or chair, and crews would notify the nurse in charge of the department before leaving.

Health Secretary Steve Barclay said ambulance handover delays were largely triggered by “those who are fit to leave hospital but delayed in doing so”.

He said: “We need to free up that bed capacity and that is often about having the right social care provision to do so.

“That’s why we’ve got an extra £7.5 billion going into social care over the next two years and an extra £6.6 billion into the NHS to tackle that issue of patients who are fit to leave, who are often delayed in doing so.

“That in turn is the best way of relieving the pressure on A&E and ensuring that ambulance handover times are reduced.”

He said high rates of flu and Covid and parents seeking help over Strep A fears had also contributed to pressure.

• If you have experienced a long wait for emergency care and want to share your story, you can email [email protected]

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