Pressure on beds in the NHS in England has become so acute that on any given day last winter, the equivalent of more than 5 extra hospitals’-worth of beds had to be brought into service to cope with surges in demand, including here on the Isle of Wight.
On the single busiest day last winter, an extra 4,390 beds had to be opened, equivalent to more than 7 extra hospitals in 1 day. On average, over 95% of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy rates exceed 85%-90%, there is an increasing risk of infection.
Given that pressures on the health service have not lessened over the last 12 months, Trusts will face similarly high bed occupancy rates this winter.
These are the findings of a new analysis by the Nuffield Trust health think tank, the first of a new short series of briefings from the Trust examining the extra pressures on the NHS in winter. Last week NHS England published the first of its weekly statistical bulletins for the current winter, with the second week’s figures expected shortly.
The report by Nuffield Trust explains that high bed occupancy rates are a real problem for both patients and staff in the NHS:
- As occupancy levels rise, it gets harder and harder to find beds for emergency patients who need to be admitted from A&E – affecting a hospital’s ability to meet the standard that 95% of patients attending A&E should be treated, admitted or discharged within four hours
- High rates of occupancy lead to problems in maintaining cleanliness and infection control
- High levels of bed use can make patients’ experience of hospital unpleasant and disruptive, as patients are moved around to accommodate others, or placed on inappropriate wards (elderly patients on obstetrics wards, for example) when there are no free beds on the right ward for them
- Hospitals need some slack in the system to be able to deal quickly and efficiently with outbreaks such as flu and norovirus, where numbers affected can rise very quickly
The report also finds that throughout the week commencing 25th January, St Mary’s Hospital was full every day with 100% of its acute beds occupied, including extra escalation beds brought in temporarily.
Commenting on the findings, Prof Appleby said:
“Our analysis shows just how acute the pressure on beds was last winter, with around 95% of the beds in all hospitals in England occupied every day. With such high levels of bed occupancy linked to higher infection rates and longer waits in A&E, these pressures pose a real threat to the smooth running of hospitals and, ultimately, to patient safety.
Article continues below this advertisement “What’s more, the NHS is going into this winter in an even worse position than it was a year ago, with record deficits, worse performance against the A&E target, far more trolley waits, record delayed discharges from hospital, and fewer people getting the help they need with social care. When you add into that mix the sort of intense pressure on beds we’ve demonstrated hospitals experienced last winter, patients’ care is bound to suffer”.
Commenting on the briefing paper from the Nuffield Trust, Isle of Wight NHS Trust Chief Executive Officer Karen Baker has said:
“At times we struggle with an imbalance in admissions and discharges. It only takes a few patients one way or the other to tip us into difficulties. Unlike the mainland, as a small Island we are unable to rely on the support of neighbouring hospitals or care facilities in neighbouring counties. We cope by opening additional capacity but that can be at the expense of patients waiting for surgery.
“We are well aware of the risks involved in operating at such a high capacity and do what we can to mitigate against the risks, including bringing in extra staff. Despite the pressures we are facing the Trust has a good record on infection control with zero MRSA cases and only four cases of C. Difficile (below the national target) this year.
“Our work with partner agencies recognises that we cannot continue providing services in the same way because of the pressures in the health and care system. Our new model of care will see more patients treated in their own homes or closer to home and fewer admissions to hospital. This week, due to the pressures we are experiencing, we have implemented an expanded 24/7 fast diagnosis, treatment and discharge to home service.”
