The NHS bed blocking crisis: Should we be worried about it in North Herts and what is being done to solve it?

Precious Phiri, Deputy Manager and Roy Tindall, resident at Burleigh House care home (Image: Archant)

The national media would have us believe that our NHS hospitals are backing up with elderly patients too weak and ill to be sent home, and with nowhere else to go.

This apocalyptic picture, we are told, puts intense pressure on the other end of the system reducing the number of beds available for patients coming into A&E and causing emergency rooms and corridors to become nightmare waiting rooms with people wired up to drips on plastic chairs or left lying in brightly lit corridors on trollies,

The picture sounds little better than the grim image of wartime field hospitals depicted in paintings of First World War.

But must we really concern ourselves with this outside of the London metropolis, in leafy North Hertfordshire?

The official answer is yes. The latest statistics for the county released by the GMB union suggest the number of days of hospital care lost to bed blocking across Eastern England Hospitals since 2011 is up by 39 per cent as compared to an increase of 26 per cent across England as a whole.

Hertfordshire is officially ranked the third worst area out of 11 East of England counties for bed blocking, with a 10,767 day or 24 per cent increase in bed blocking between 2011 to 2015.

The GMB puts these worrying stats down to delays caused by finding places in care homes, arranging further NHS care, sorting out care in peoples’ homes and delays due to families making choices about their loved ones’ future.

The report lays the blame on government funding cuts which is says have caused local authorities to slash their social services provision.

But as far as North Herts is concerned, this is all a tad misleading and in North Herts itself the picture is in fact much brighter..

At the East and North Herts NHS trust which runs the Lister Hospital, has set its own target to have less than eight beds blocked each day. The only time in the past year when it missed this target was in June and November when there were nine beds blocked, September when there were 11 and December when there were ten.

This compares well to many hospitals where entire wards of 30 people may sometimes be full of people whose discharge has been delayed.

Staff at the Lister Hospital would be the first to admit they have had a trying winter, with an influx of patients - particularly the elderly - admitted with winter viruses that can prove fatal.

Its A&E department has also been overloaded at times and people with minor injuries were turned away for 24-hours in january when staff were struggling to cope.

The Trust says the average number of patients admitted as inpatients over the winter sits at about 2,900 per month - which it says creates “real pressures” in terms of bed capacity and says the number of people waiting to be discharged from the Lister is always a factor.

But it claims the relatively low numbers for North Herts are explained by the “excellent relationships” it has developed with those who look after patients once they leave hospital, notably Hertfordshire County Council, the East and North Herts Clinical Commissioning Group and the many care homes and care providers.

The Trust’s chief executive Nick carver said: “Delayed transfers of care - often known as bed blocking - can be a real problem for NHS hospitals, especially during the very busy winter months.

“Here in Hertfordshire we have seen a real fall in the number of hospital beds occupied by people who fit and ready to be discharged, but are not able to do so because the next stage in their on-going care is not in place.

“Close working between the Trust and its colleagues in social, community and primary care has seen the average number of beds blocked in this way each month reduce to the point where Hertfordshire is one of the better performing areas of the country.”

But is it is also clear the problem is far from being solved and a particularly tough week or two can still stretch the system to breaking point.

Mr Carver added: “That said, we have seen rises over more recent months and more work needs to be done to drive these improvements further. This is especially the case for those patients with much more complex needs who can be difficult to discharge in to the right place to meet their on-going health and social care needs.”

New solutions:

The main responsibility for making sure people stay in hospital for as little time as possible is that of the NHS East and North Hertfordshire Clinical Commissioning Group. This is managed by doctors and has powers to buy services like places in care homes and home nursing support.

The CCG says it is successfully promoting key initiatives to get people out of hospital more quickly.

Its new Vanguard project is training care home staff to deal with medical problems including dementia, nutrition, falls, wound management and health, continence, neurological and respiratory conditions.

A spokesperson for the Trust said: “This expertise will help residents to stay as healthy as possible and support staff when they make decisions about whether to send care home residents into hospital for treatment.

“It is hoped that in future, people in care homes can avoid being admitted to hospital for very short stays, when their care can be managed in the home instead.”

So far, staff in 11 Hertfordshire care homes have been trained under Vanguard.

As one of six Vanguard projects nationally, the Trust says the Hertfordshire scheme is benefitting from exchanging ideas and advice with the others across the UK.

Meanwhile a new service called HomeFirts has set up a ‘rapid response’ service for people in a crisis.

This means if someone falls ill they can get a visit from a medical professional within an hour of calling the hospital. The hope is they won’t have to go to hospital at all.

In its first year of operation more than 2000 people weer treated under the HomeFirst Scheme in Hertfordshire.

Dr Alison Jackson is a GP who has supported the development of HomeFirst.

She said: “When someone is ill, particularly if they are also elderly or frail, a stay in hospital can be a disorientating experience. HomeFirst allows us to treat people without disrupting their important, familiar routines, or separating them from family and friends who can support and reassure them.

“HomeFirst also provides a rapid response service for people in a crisis, responding within an hour when urgent help is needed by someone who would otherwise have to be admitted to hospital.”