NHS Bed Crisis–A Threat To Patient Safety

March against the closure of Ealing Hospital – over 600 beds are under threat in north west London
March against the closure of Ealing Hospital – over 600 beds are under threat in north west London

THE NHS Bed crisis is a threat to patient safety, doctors have warned as the latest figures were released showing hospitals working at full capacity.

Doctors union BMA said: ‘A decade-long drop in overnight hospital beds has created a “mismatch” between supply and demand in the NHS.’ This is one of the key findings from analysis by the BMA of bed numbers, occupancy and rising demand across the UK. Doctors have reported ‘substantial problems and strains’ in the NHS bed system.

‘In the UK, at a time when demand for NHS care is growing, the number of beds has continued to decline significantly,’ the report adds. There is a concern among doctors and other healthcare professionals that staff may feel pressured to free up beds. In the worst-case scenario this can lead to patients being discharged before it is safe or appropriate to do so.’

The report, State of the Health System, Beds in the NHS: UK, finds that in England: • In the first week of January 2017, almost three quarters of trusts had occupancy rates of more than 95 per cent on at least one day

• Almost one in seven patients waited more than four hours in emergency departments for beds last November

• A 44 per cent drop in mental health service beds has led to ‘particularly acute pressures’. On average, 726 patients had to be found beds out of their areas between March and October last year.

BMA council chair Mark Porter said: ‘High bed occupancy is a symptom of wider pressure and demand on an overstretched and underfunded system,’ he added. It causes delays in admissions, operations being cancelled and patients being unfairly and sometimes repeatedly let down. The delays that vulnerable patients are facing, particularly those with mental health issues, have almost become the norm and this is unacceptable. Failures within the social care system are also having a considerable knock-on effect on an already stretched and underfunded NHS.’

The report recommends several measures for NHS bed plans to help close the gap between supply and demand, including:

• The need to plan ahead for service demands and anticipate changes in population health needs

• A focus on quality care, safety and patient experience

• Funding and support for community care so patients can leave hospital without delay

• Prioritising mental healthcare close to patients’ homes.

The Department of Health said the figures were from different time periods when the ‘way of counting beds was different’, but BMA analysis shows the number of beds decreased steadily in both periods. The latest NHS bed occupancy figures are the highest ever recorded for a third quarter since quarterly data collections began in 2010, providing a further sign of the system’s capacity challenges.

The average occupancy rate for all beds open overnight between October and December 2016 was 88.3 per cent – up from 87.2 per cent for the same quarter in 2015-16 – against the 85 per cent standard. Higher bed occupancy figures have only ever been recorded in fourth quarters, which are usually the busiest period of the year for the NHS.

Overall bed occupancy rates were 89 per cent in quarter four of 2015-16, and 88.5 per cent in quarter four of 2014-15. The average occupancy rate for general and acute beds open overnight in quarter three this year was 90.5 per cent, compared with 89.1 per cent a year earlier. However the situation will get a lot worse if Tory plans are not stopped in their tracks.

The Tories secret Sustainability and Transformation Plans (STPs), which have now been made public through leaks show that thousands of beds will be cut in hospitals up and down the country. A new report from the King’s Fund think tank has warned that the number of hospital beds could destabilise services that were already ‘stretched to their limits’ after the Winter.

Sustainability and Transformation Plans (STPs) have been put forward by NHS chiefs in 44 areas in England as part of a national programme by the Tories to cut, shut and privatise hospitals. King;s Fund Chief Executive, Chris Ham said that the NHS cannot realistically cut the number of beds when this winter had shown that they were needed.

The cuts could include a 44 per cent reduction in inpatient bed days in south-west London and a cut in hospitals in north-west London from nine to five, with the loss of over 600 beds. Hospital beds in Dorset could also be from 1,810 to 1,570. Last November, the King’s Fund said STPs had been kept secret from the public and barely involved frontline staff.

NHS England even ordered local health leaders not to reveal plans to the public and refuse Freedom of Information Act requests. The STPs will see the A&E dropped at the Poole and Bournemouth hospital, hospitals reduced from three to two in Leicestershire and Rutland, four community hospitals closed in Devon, and 200 beds taken away at Nottingham University Hospitals NHS Trust.

Derbyshire plans to slash 400 acute hospital beds, Herefordshire and Worcestershire anticipate a ‘significantly lower’ number, and Cambridgeshire and Peterborough will centralise orthopaedics, stroke, maternity and paediatric services.

• GPs are getting their ‘arms twisted’ to sign new premises’ leases by NHS England, who are threatening that if they refuse they will have their funding stripped. Practices who have been waiting more than a year for premises investment have been told by NHS England their funding will be pulled unless they sign new leases which are currently being disputed.

One practice, which has invested thousands in contractors and surveys for NHS England due diligence requirements in order to complete work this financial year, said they were having their ‘arms twisted’. The issue focuses on practices in NHS Property Service premises which last year began a programme to standardise its leases, many of which transferred over on long-standing, informal PCT arrangements in 2013.

NHS England has said it needs to guarantee practices have ‘security of tenure’ before investing funding committed via its delayed £1bn Estates and Technology Transformation Fund (ETTF).

But practices have complained of ‘financially crucifying’ service charges which would come into force under the new arrangements, and contesting future increases would become more difficult once signed up to the new lease.

GP leaders said practices needed time to ensure they were satisfied with the lease and said they should not be ‘cajoled into taking shortcuts’ when signing a legally binding document. Dr Gaurav Gupta, a GP partner in Faversham and a vice-chair of Kent LMC, said that his practice started applying for ETTF funding in February 2016 and had completed bids and project initiation documents.

Last November they were told they were in ‘cohort one’ for funding, which means they have a deadline of April 2017, pending due diligence checks. Dr Gupta said these checks required architect’s plans, asbestos surveys and thousands in professional fees but they are now ready to go in a week’s time – ahead of the end of financial year deadline.

He said: ‘Now, six weeks before year-end they’re coming to us to say “you need to sign this”.

‘They’re not saying we will stop you if you don’t sign this. But they did say: “Can I please reiterate that this ETTF-funded project is at risk without the necessary security of tenure”. But it’s the same thing.

‘NHS Property Services (PS) actually belongs to the government, but one arm doesn’t know what the other is doing and they’re trying to gang-up on practices to make them sign things. They’re twisting our arm.’

The end of year deadline adds pressure to get the issue resolved, and Dr Gupta says he thinks ‘around 150’ NHS Property Services practices are in a similar situation. He added: ‘Most NHS PS buildings are struggling for space, they haven’t had any investment for a while, so in terms of need they might be some of the highest need practices.’