University Hospitals of North Midlands NHS Trust (UHNM) is appealing for support from the local community to reduce the pressures on hospital services through responsible use of A&E, and by helping their relatives to return home or to their next place of care in a timely manner once they no longer need a hospital bed.
Despite regular appeals, seven in ten of those attending A&E do not need to be admitted and many of these could be treated elsewhere. The hospital also regularly has patients who are waiting for relatives to come and collect them, which prevents beds being used for those most in need causing a gridlock. This has a knock-on effect on the cancellation of routine operations.
During the summer 150 patients on average are admitted to hospital every day at Royal Stoke University Hospital and County Hospital. However, delays in being able to discharge elderly patients home or to community services means that many patients who need to be admitted have to stay in A&E for long periods waiting for a bed on a ward to become available.
A patient who is ready to leave an acute hospital to go home, to a care home or to a community hospital is known as ‘medically fit for discharge’. These patients are sometimes delayed leaving the hospital whilst they wait for their family to collect them, for families to agree where on-going care can be provided, for a home care package to be agreed or for a community bed to become available.
University Hospitals of North Midlands does plan for nearly 70 patients who are medically fit for discharge being delayed at any one time. However, this summer the average number of patients who are medically fit for discharge has exceeded 150, and recently reached 200, which is 15% of all beds available at the hospitals.
Mr Robert Courteney-Harris, Chief Executive, said: “The number of people who are ready to go home but are stuck in a hospital bed has reached crisis levels. Our staff are concerned for both the safety and experience of our patients, which is why I have agreed to pay for additional out of hospital beds as an emergency measure, even though this is not something the Trust is funded to do. Discussions are continuing with the City and County Councils and our local Clinical Commissioning Group to try and find a longer term solution, but there have been several nursing home closures in recent weeks which have compounded the situation.
“The public really can make a difference, and we are appealing to families for their help in getting their loved one home as quickly as possible. That may be collecting them in midweek rather than the weekend, right through to trusting us to discharge their loved one to the place of care where they will get the best treatment, which may not be the closest option.
“Everyone can help us by spreading the message about using the many alternative NHS services to A&E. Only 30% of patients who attend A&E need to be admitted. If there is a reduction in the number of walk-in patients attending we will free up vital clinical staff to care for those patients who do need to be admitted. We’re making more of our clinical staff available during this exceptionally busy summer, but the concern is that without the support of the public we will have a significant increase in cancelled operations due to bed shortages and even longer waits in A&E.”
Dr Simon Ellis, Chair of Medicine, said: “An elderly relative lying needlessly in a hospital bed for a week will suffer loss of muscle strength and bulk which will take months to recover. We think of a hospital as a place to get better, but a considerable and unnecessary amount of time in a hospital bed does far more harm than good. This is because you can start to lose your mobility and your independence, which is the last thing most people want. We do have relatives who don’t want their loved one to go to a home or a community hospital that may not be their first choice or is a little further away, but in doing so they are helping both their loved one and other patients who desperately need a bed.”
Dr Julie Norton, Clinical Lead and Emergency Medicine Consultant, said: “We’ve seen days this summer where more than 600 people have attended our A&E here and in Staffordshire. Although many walk-in patients do need emergency care, only 30% of the 600 people attending needed to be admitted to a hospital bed. This means that there are many people who could have chosen an alternative to A&E. Our Emergency Centre staff are here to treat accidents and emergencies so my team are asking everyone to please use services wisely and allow us to focus on the people that really do need our care.”
If your relative is ready to be discharged, please contact the ward for advice on how you can help their discharge. The public can find out more on how to keep well and where to get expert advice at www.nhs.uk/staywell. Those people attending A&E who do not require immediate, emergency treatment may have a considerable wait.