latest health care news

10.12.15

Tiny number of patients have huge effect on bed capacity and winter pressures

The NHS’s top priority this winter should be focused care for the small number of mainly frail and elderly patients who have a hugely disproportionate effect on bed capacity, according to the Nuffield Trust.

Its analysis shows that just 3.6% of patients took up over a third of all bed capacity in acute hospitals in England last year, and with no extra ‘winter pressure’ money forthcoming this year, the position will be even worse in the coming months.

Report author Sasha Karakusevic, whose full research paper is to be published in the new year, said: “It is clear that frontline staff across the health and care services are working very hard to do their best for patients. But demand is outstripping capacity at present, as it did last winter, and very focused action that addresses the pinch points is needed now.”

The patients who need extra focus from the NHS are typically those unable to return to their own homes or to nursing or residential homes when their medical treatment is finished.

Many trusts had to declare ‘black alerts’ and ‘major incidents’ last winter, such was the scale of demand, with performance against A&E waiting time targets the worst for a decade and bed occupancy running far higher than the 85% recommended as the maximum.

But the Nuffield Trust says ensuring this 85% limit is not breached would require 14,000 more beds across the NHS, which it admits is not a realistic prospect, and not actually a desirable outcome. The real problem is in other parts of the system.

Nuffield Trust chief executive Nigel Edwards said: “These figures show exactly why NHS trusts found it so difficult to meet the four hour A&E target last winter – despite being able to take advantage of record funding specifically intended to deal with winter pressures. Given that there is no extra money for winter this year, they are likely to find it even more difficult to cope in the coming months, especially as almost all Trusts are now in deficit.

“Because such a small percentage of patients, most of them frail and elderly, occupied so much of hospitals’ bed time last winter, even a tiny fluctuation in numbers among these patients had a disproportionate  impact on the number of beds a hospital could free up. 

“This winter, the NHS’s top priority should be to improve care for this small group of patients.  For many, the problem is not that simple improvements like grab-rails and ramps are needed before they can return to their own homes, though that would certainly allow a number to leave hospital; it is that they are too frail to return home at all in the short term, and instead need intermediate care beds in the community. But as we made clear in our response to the chancellor’s Spending Review, social care services struggling are to carry on.”

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