NHS' summer crisis: Wiltshire's soaring number of hospital bed days lost to delayed discharge of patients

Written by Tony Millett on .

[Click on image to enlarge it][Click on image to enlarge it]Once upon a time the summer was when the NHS planned for the onslaught of winter illnesses and limbs broken on icy paths.  Now it seems to have become just another period of crisis.

The outstanding problem for the NHS in Wiltshire has come in the shape of a sudden spike in the number of hospital bed days lost to delayed transfers out of wards for those fit to leave - also known as 'bed blocking'.  

This is one of the key factors in long waits in A&E - if beds are not freed up quickly, patients who need to be admitted for treatment have to wait in A&E.

Figures given to Wiltshire's Health and Wellbeing Board (September 22) show the number of beds blocked in this way have reached the levels of the bad old days of 2014-15.  

As the graphs show (right) all three of the acute hospitals that serve Wiltshire have had steep rises in bed days lost by delayed transfers of care.  When summer ends winter is not far behind - as Council leader Lady Scott pointed out: "Those numbers are going up and we're getting into the time when things get worse."

James Roach, director of integration for the Council and Wiltshire Clinical Commissioning Group (CCG), told the Board: "The system is challenged at the moment...We are where we are and we're not going to solve this overnight."

A Wiltshire Council associate director suggested the council may be aiming to do too much for patients who are going back to their homes or into non-hospital care - and so delaying their transfer out of their hospital bed. He wanted to revisit the Care Act to see what they are required to do.

Of course, the problem is that by doing any less for a patient's support at home, they may free up a bed sooner, but may also hasten that person's return to hospital.

The fragility of the social care system at present is well illustrated by one of the Council's contractors for its Help to Live at Home (HTLAH) scheme.  Following an inspection, the care Quality Commission (CQC) put restrictions on MiHomecare - this led to sixty discharges a month being lost.  In turn this lessened the effectiveness of the Urgent Care at Home programme.

One of the key ways it is hoped improvements will come is to put HTLAH staff into each of the three acute hospitals and to integrate the HTLAH service with existing adult care teams working in the community.  

Some new HTLAH providers began at the start of this month - for instance Mears Care took over in the Marlborough area.  The reliance of the system on these Wiltshire Council HTLAH contracts was made plain to the board.

This set-back comes as the Better Care Fund projects run jointly by the Council and the CCG have been showing positive results in terms of fewer hospital admissions for the frail and elderly - especially among those in care homes.

But the one common theme in trying to sort out these issues is the workforce.  The dearth of appropriate staff has reached the point at which new initiatives involving new jobs are stymied simply because staff are likely to be taken away from other vital roles in the health and care system.

Sustainability and Transformation Plans - STP:

The board heard an update on the STP proposals from James Scott - Chief Executive of Royal United Hospital in Bath and convenor for the STP across the 'footprint' covering Wiltshire, Bath and North-East Somerset and Swindon.  

His paper before the board described the broad aims of the STP - and he did say that unlike some STP's which have really challenging financial problems to resolve: "Ours is not that contentious - it sets out priorities.".

Details and how the plans will be put into practice (watch for the key-word 'implementation') will not be opened to the public until January 2017.  

By then the plans will have been approved (or not) by NHS England and NHS Improvement and any consultation with the public will presumably be about fine details - like opening hours for services and, perhaps, costs for parking at hospitals.

James Scott has set up a Clinical Board representing the three parts of the STP 'footprint': "This will become our engine room - it will fundamentally drive changes."  What this will mean for the role of the CCG itself will become clearer - it is hoped - with new guidance being issued now by NHS England.