13 hours agoShareSaveNick TriggleHealth correspondentShareSaveBBCAs ambulances queued in front of Royal Berkshire Hospital in Reading last week, corridors full of patients were waiting for a bed on a ward. Emergency department consultant Omar Nafousi was at his wit’s end.”We’ve no space,” he told the BBC last week. “This is not what I signed up for when I became a doctor.”It is a scene that is being repeated in hospitals up and down the country as winter viruses and cold weather add to the pressures on the health service. Currently nearly 4,000 beds in England alone are taken up by patients with flu, Covid and the vomiting bug norovirus, according to NHS England, and the situation is on a similar scale in the rest of the UK.But that is dwarfed by another pressure – the patients who should not be in hospital.In Pictures via Getty ImagesEvery day there are more than 13,000 people whose treatment has been completed who are still in hospitals in England, the latest figures from NHS England suggest. Plus there are a further 4,000 around the rest of the UK – which means around one in eight beds are occupied by people who don’t necessarily need to be there.Many of these “delayed discharge” patients are older and may be frail and living with multiple health conditions who need support in the community.But it comes at a huge cost. The average hospital bed takes £562 a day to staff and maintain, according to NHS England, meaning the health service in England is losing more than £225m a month supporting patients who could be elsewhere.Then there is the cost to other patients. “We are seeing surgery cancelled and long waits in A&E because there are no beds available on the wards,” says Clifford Kilgore, a senior nurse working with older people, who serves on the Nurses and Allied Health Professionals’ Council of the British Geriatrics Society.As for the staff there is a toll on morale, too – among doctors, nurses and ambulance workers. “It’s terrible when you see patients go downhill in hospital when you know they would be better off somewhere else,” says Laura Hichens, a nurse who leads the “discharge liaison” team at Queen Elizabeth Hospital in Gateshead.The issue of delayed discharges is far from new. For years, it has been talked about, if not agonised over, and the NHS started tracking the delays in the early 2010s. Last summer, the government launched an urgent and emergency care plan, which pledged to reduce the delays, with the promise there would be improvements.If it could be solved, the impact on the NHS would be transformative, experts have told me. Yet the problem throws up many deeper questions about the care system, coordination and planning in hospitals – with some doctors even asking whether the NHS is over-treating patients, particularly those at the end of life.’The system’s running faster just to stand still’On paper, it all sounds straightforward: simply send all those patients who are well home. But it’s not that easy.”It takes a lot of time and effort to discharge a patient,” says Emma Dodsworth, a researcher who has studied the issue for Nuffield Trust think tank. “Some may need adaptations to their home, some short-term help with washing and dressing or home visits from nurses. Some a combination of all three, while others may need a care home place to be found.”And because the population is getting older and frailer, there are more complex cases ending up in hospital. The system is having to run faster just to stand still.”Arranging the discharge of these patients relies on a close relationship between council-run social care services and the NHS.Getty ImagesThere are plenty of examples of this happening. At Gateshead’s Queen Elizabeth Hospital social workers and nurses are working side-by-side in the discharge liaison hub, which has been fully up and running for two years. The hub also has a housing officer, employed by the council, to arrange home adaptations or temporary housing.Planning for discharge begins as soon as a patient is admitted to hospital. “That means when they are ready to be discharged it can be done pretty much straight away for many,” says Hichens.Figures show the hub consistently discharges patients more quickly than average.It’s a template that some might suggest should be rolled out en masse across the country – but so far that hasn’t happened.’Strained relations’ with social careA recent report by the NHS Confederation and Association of Directors of Social Services (ADASS) warns that cooperation between the NHS and social care sectors is “inconsistent” across the country with relationships sometimes becoming “frictional”.Kerrie Allward, who acts as a policy lead for ADASS and is executive director for adult social care and health at Walsall Council, is not surprised by these findings.Her area has adopted a similar approach to Gateshead and she says that led to a five-fold drop in delayed discharges in the year after it was introduced.But she argues that across the social care sector m …
