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Patient safety at risk as over 65 trusts operating at near-full capacity

Although high bed occupancy rates have become routine in the NHS, that does not mean they are acceptable – and continue to pose a serious threat to patient safety and infection rates, NHS Providers has said in response to stark new findings on overcrowding.

An investigation based on NHS England data from the peak of winter – the start of December last year to 22 January this year – conducted by the BBC revealed that a whopping 90% of trusts in England have surpassed the acceptable rate of bed occupancy.

A total of 137 out of 152 hospital trusts were said to be running over the 85% bed occupancy threshold, with 66 even recording rates of over 95% – such as Basildon and Thurrock University Hospitals. Its interim managing director, Tom Abell, told the BBC that whilst before it would be unusual to see more than 350 people in the trust’s A&E in one day, this is now the norm.

Chris Hopson, the chief executive of NHS Providers, underlined the “strong evidence” that shows having bed occupancy rates above 85% can compromise patient safety, increasing the risk of infection. High rates also mean hospitals have less capacity to deal with unexpected demand, such as flu outbreaks – which are especially common over winter.

“Working in this way is inefficient. It often forces staff to delay operations because of a lack of suitable beds. This can be very distressing for patients and carers,” added Hopson.

“High bed occupancy rates have become routine in the NHS. But that does not mean they are acceptable. They are an important indicator of unsustainable pressures on the whole health service, which have reached unprecedented levels in recent weeks.”

One patient, Richard Taylor, told the BBC that he was even forced to watch his mother die in an “undignified way” from cancer because Liverpool’s Aintree Hospital was so full that staff were unable to give her end-of-life care. She spent 13 hours on a trolley waiting for a bed before being admitted.

As well as impacting patients and quality of care, high occupancy rates can also be demoralising for staff, who have so far “responded heroically” to swollen demand, argued Hopson.

He reiterated NHS Providers’ call from last week that NHS England and NHS Improvement should lead an urgent review into how hospitals account for winter pressures by April this year – a demand that was firmly backed by other health heavyweights, such as Dr Sarah Wollaston, chair of the Health Select Committee.

Today’s findings trail closely behind several similar reports of the ongoing NHS winter struggle. In mid-December, Nuffield Trust argued winter hospital bed shortages pose a “real threat” to patient safety.

Earlier this year, as winter was really beginning to bite, more than 20 trusts had also issued ‘black alerts’ – meaning they were officially unable to guarantee patient safety.

Engaging the public

Overall, the BBC analysis found that another 20 hospitals would be needed to bring NHS to safe levels. As part of an accompanying poll, conducted by Ipsos MORI, the broadcaster also concluded that over half of respondents argued it was getting harder for the NHS to deliver the care and services it provides.

Almost 60% of respondents also thought that a shortage of staff and equipment or a lack of appropriate funding was piling on pressure on the NHS to deliver these necessary services.

Hopson said it was “heartening” to see wide recognition of the intense pressures the health service is facing, but argued that arguments about the impact of an ageing population have not yet cut through.

“This underlines the need for a proper public debate about how we protect services at a time of growing demographic pressures,” he added. “These will have huge implications for the NHS and other public services in the coming years. We cannot afford to duck this debate.”

An NHS England spokesman acknowledged the impact of pressures on hospitals, but argued that the biggest culprit and the “single most helpful change” would be tackling delayed discharges, a persistent problem in the health service.

While the NHS has been dealing with ever-growing incidents of delayed discharges, some of the responsibility also falls on local government, which has to provide community support or care teams that can help patients be discharged from hospital earlier.

(Top image c. Chris Radburn, PA Wire/PA Images)

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