The CEO of NHS Providers has revealed that some 20,000 'bed blockers' – medically fit patients ready to be discharged, but with nowhere to go – are taking up more space than COVID patients in England’s overwhelmed hospitals, writes Sarah Knapton for The Telegraph.
Chris Hopson, the chief executive of NHS Providers said that the number has approximately doubled since December 2021, when around 10,000 patients were waiting to leave hospital.
According to The Telegraph story by Sarah Knapton, published on 17 April 2022, latest NHS England figures for April showed there are currently around 88,000 patients in NHS hospital beds, but the new figures show nearly one quarter do not need to be there.
In contrast, there are around 15,000 COVID patients in hospital, of which roughly 8,500 were admitted for a different reason, with coronavirus admissions falling since the beginning of April.
In a lengthy Twitter thread on Sunday, Hopson said the NHS was “facing major difficulties” and warned that a “major contributory factor” was the inability to promptly discharge thousands of medically fit patients.
“[The] NHS has been working really hard to improve discharge and flow, but finding this difficult,” he said.
“We need right funding, right size of workforce, right support for social care, right level of NHS capacity to meet growing demand and a funded change programme.”
The Association of Directors of Adult Social Services (ADASS) has warned that the care sector is in the middle of a national crisis with 100,000 vacancies and staff leaving for better pay in shops and bars, The Telegraph story continues.
The sector was badly hit by the government's mandatory vaccination policy, which saw thousands of workers forced to leave the profession after refusing to be jabbed. There are also increasing numbers of staff off sick or isolating from COVID.
The government has promised a record £39 billion over the next three years for the health and social care system but the care industry has warned that even with the extra funding it could face a £1.3bn deficit by 2023.
Serious worry
Hopson, who last weekend called for a return to masks and social distancing, said current pressures on the health service are a “serious worry” as he called for ministers to act.
However Dr Raghib Ali, the senior clinical research associate at the MRC Epidemiology Unit at the University of Cambridge, resisted the call for a return to restrictions, but said people could do more to ease the situation, The Telegraph wrote.
“The NHS is the busiest it has been throughout the pandemic – primarily now due to non-COVID – but we can help reduce pressure by following basic public health guidance; staying home when symptomatic, which will reduce infectious disease spread so everyone can receive the care they need,” he said.
The Chris Hopson Twitter thread
@ChrisCEOHopson
Sunday 17 April 2022
Where's NHS up to? Flat out, doing its best for patients, as ever. But struggling with COVID and impact of long term fault lines. Concerning pressure, despite front line effort. Sits alongside interview today with The Sunday Times (see link below).
At last week’s @NHSProviders Board, 20 experienced chairs and CEOs from all NHS geographies and sectors universally agreed this was longest and most sustained period of NHS pressure they had seen in their careers.
Incredibly grateful, yet again, for commitment of staff but serious worry at the impact that current pressures are having on patients and frontline staff. NHS is currently grappling with four big, inter-related challenges. Together, they explain why the service is facing major difficulties as we come out of winter.
Challenge 1
Much higher levels of COVID prevalence than we were expecting, and anyone had predicted, at this point. 15,000 patients with COVID in English hospital beds on 14 April, compared to 8,210 six weeks earlier. Numbers growing, not falling as we had expected.
Majority in hospital with, not because of, COVID. Success of NHS vaccination campaign and new treatments mean much lower levels of serious illness/mortality than before.
But operational consequences are same – need to separate COVID/non-COVID patients across all services, making it much more complex/difficult to run inpatient hospital/mental health services and significantly reducing productivity.
COVID also causing higher staff absences – 70,000 on 7 April (last data), 40% due to COVID. COVID impact also hitting social care hard, on top of long standing pressures that have considerably deepened over last few months.
Major contributory factor [is] inability to promptly discharge 20,000 medically fit patients. NHS been working really hard to improve discharge and flow, but finding this difficult.
Government doesn’t seem keen to talk about COVID. But vital it does. To explain current pressures on NHS. To explain current risks and what we can all do to mitigate them without returning to restrictions. And to enable NHS to plan properly for further waves we know will come.
Challenge 2
Very pressured urgent and emergency care pathway. Worryingly high levels of delays in answering 999 calls, conveying patients to hospital, ambulance handover delays outside hospitals, 12 hour waits in A&E and delays for urgent mental health care.
Statistics show, and staff and patient testimony illustrate, pressures are significantly greater, lasting longer and more geographically widespread, than we have seen before. Especially outside winter. Not just a temporary overload in a small number of places.
This is why NHS leaders are working so hard, at pace, to do all they can to manage the increased risk to patient safety and to stabilise emergency care, supporting ambulance services as effectively as possible. But, again, sustained improvement is proving difficult.
Challenge 3
Care backlogs. NHS [is] working flat out to get through backlogs, reflected in latest statistics. 200,000 more diagnostic tests in February 2022 than in same month last year. 16% more people seen within two weeks of urgent cancer referral versus pre-pandemic February 2020.
NHS agreed with government to concentrate on eliminating longest waiters – 104 weeks+ – by end June 2022. Latest stats show good progress/on target to achieve this. But current pressures mean majority of trusts are finding it difficult to hit top speed on backlog recovery as they wanted to, coming out of winter.
Trusts looking to hit 104% of pre-COVID levels of elective activity this year as quickly as possible. To build to 130% by 2024/5. Some reaching 104%, a few exceeding it. But majority in 90%’s due to combination of above pressures…
[It is] important to recognise [the] huge amount of good, innovative, work being done to speed up backlog recovery. New surgical hubs, community diagnostic centres and mobile cataract units. Combined with huge extra effort from frontline staff – extra shifts and weekend lists.
Also important to remember backlogs exist across all NHS services including mental health, not just elective surgery. For example, backlogs in community services and children’s services. They need backlog recovery plans too!
Challenge 4
The biggest challenge of all. Trusts [are] struggling with workforce shortages. 110,000 vacancies. Recent NHS staff survey showed only 27% of staff say there are enough staff in their organisation to do their job properly.
Real worries about current load on staff: 47% of staff say they've felt unwell due to work related stress over the last 12 months; 34% say they feel burnt out because of their work; 31% say they feel exhausted at the thought of another day or shift at work. Trust leaders really worried about impact on retention.
Worth flagging, in addition, [is] that the understandable focus on new health and care levy at a time of cost of living pressure is obscuring the level of challenge on NHS 2022/23 finances. Overall, NHS frontline budgets have only increased by 1.99% versus 2021/22.
NHS now asked to find further £300m savings to cover costs of testing/surveillance. 1.1% efficiency requirement doubled. Estimated further £1bn pressure due to higher inflation. Many trusts [are] worried about ability to hit budgets and resulting impact on care provision.
And all this comes at a time of significant structural changes as health and care create the new statutory Integrated Care Systems (ICSs). [This is an] important step but one that is understandably requiring significant leadership time and focus alongside major operational challenges.
These pressures are a result of four long term fault lines built up over [the] last decade. [The ] longest/deepest NHS funding squeeze ever. NHS therefore unable to build extra capacity to meet growing demand. Rising workforce shortages. Government failure to address problems in social care.
Current pressures have triggered usual suspects, stage right, suggesting [the] NHS model is broken/NHS badly led/NHS inefficient. Of course NHS can improve. [A] properly funded transformational change programme [is] needed – digital, integrated care, 21st century personalised medicine.
But [the] overwhelming majority of public agree with NHS's founding principles: 94% believe NHS should be free of charge when you need it; 86% believe NHS should primarily be funded through taxes. And 84 % believe NHS should be available to everyone.
We need [the] right funding, right size of workforce, right support for social care, right level of NHS capacity to meet growing demand and a funded change programme to make [the] existing model work. Calls for a new model and unwarranted criticism of NHS leaders/efficiency a distraction.
The full message from Chris Hopson on Twitter
See also from the MedicalBrief archives
Medical scheme patients and the scramble for COVID beds
Gauteng’s ‘new’ R1.2bn COVID ICU hospitals lie abandoned and unfinished
Nearly 90% of COVID patients qualifying for ECMO but nor receiving it, died – Vanderbilt
Almost 12,000 people died from COVID caught in an NHS hospital in England