10 December 2015

Just 3.6 per cent of patients took up over a third of all bed capacity in acute hospitals in England last year, new analysis by the Nuffield Trust of pressures on the NHS last winter has found. The analysis comes on the day that NHS England publishes its latest monthly figures on how the Health Service is performing against a number of targets.

Given that there is no extra money for winter this year, hospitals are likely to find it even more difficult to cope in the coming months, especially as almost all Trusts are now in deficit. 

Nigel Edwards, Chief Executive

The patients in this group were likely to have been frail or elderly people who the system was not ready to return to their own homes or to nursing or residential homes, despite their medical treatment being finished.

This new figure for bed occupancy helps to explain why the Health Service still suffered a winter ‘crisis’ last year, the authors say, despite receiving record extra funding from NHS England of almost £700m specifically to deal with pressures caused by winter.  

The fact that no extra funding for winter is being allocated this year means the position will be even worse in the coming months, they argue. The Health Secretary Jeremy Hunt announced in November 2014 that the money was being awarded to the NHS to ‘make sure it is better prepared [for winter] than ever before’ - yet by January this year, a string of Trusts in England had declared major incidents or ‘black alerts’, whereby hospitals were closed to all new admissions, while performance against the four hour A&E standard was the worst in a decade.

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 focussed action that addresses the pinch points is needed now.

Sasha Karakusevic, report author

The way in which this small group of patients was treated meant that bed occupancy rates in many hospitals were running far higher last winter than the 85 per cent generally recommended by experts as the maximum that should be reached in the NHS – which in turn held up the admission of patients from emergency departments, thereby preventing those arriving at the ‘front door’ of A&E from being seen quickly enough and causing the four hour A&E standard to be breached repeatedly.

But further analysis by the Nuffield Trust has revealed that ensuring that no more than 85 per cent of beds in hospitals in England were occupied at any one time, which would then allow Trusts to admit patients from Emergency Departments quickly enough, would require another 14,000 beds to be opened in the NHS. Such an enormous expansion in beds is extremely unlikely to take place – and furthermore, would be undesirable, according to the authors.

The research shows the breadth of measures adopted by Trusts last winter to try to deal with additional demand, and the amount spent on each from the £652 million ‘pot’. The three initiatives on which the most money was spent were: 

• Providing extra beds and staff: £254 million

• Improving discharge processes: £74 million

• Seven day working: £61 million.

Commenting on the findings of the analysis, 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”.

Report author Nuffield Trust Visiting Senior Fellow Sasha Karakusevic added:

“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 focussed action that addresses the pinch points is needed now”.

Today’s data on last winter are initial findings from a full research paper on pressures on A&E by Sasha Karakusevic and others, to be published in the New Year. 

 

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