Addenbrooke’s A&E in Cambridge. Photograph: David Levene
Huge numbers of hospital beds filled with patients “trapped” despite being fit to leave are adding to the deepening chaos in A&E and forcing operations to be cancelled, a survey of NHS bosses for the Guardian has revealed.
Half of hospitals reported that at least 10% of beds are taken up by “bedblockers”, 50 NHS trust heads across England said. Twenty of the respondents said as many as one in five beds could not be used for new admittances, according to the research by NHS Providers. At Addenbrooke’s in Cambridge, one of the largest hospitals in England, 87 of 1,000 beds are filled with such patients. One has been there for 72 days after she was declared fit to leave and another for 59 days.
The hospital said 21 patients had been fit to go for at least three weeks, 11 for two to three weeks and 22 for between seven and 13 days. On Wednesday night, Addenbrooke’s declared it was in the throes of a major incident, meaning it was rationing less urgent care to cope with demand.
Its chief executive, Dr Keith McNeil, said the situation had forced the hospital to cancel planned operations such as hernia repairs, losing it vital income.
Royal Bolton, which declared a major incident on Tuesday, said freeing up beds and finding places for patients who no longer needed hospital care was its main issue. The Royal Bournemouth and Christchurch hospitals had more than 35 such patients and Peterborough hospital, which has declared its fourth major incident since the beginning of December, said it had 38. Yeovil had more than 30 while West Hertfordshire hospitals had 37 on Monday.
Inadequate social care support – a lack of care home beds and a shortage of support to keep people healthy at home – means many occupants are unable to be safely discharged despite being well enough to go home. NHS figures for November, the latest available, showed that 5,026 patients in English hospitals were ready to leave, but had no arrangements for after-care. Two-thirds were in acute hospitals, the highest number since records began in August 2010.
Two-thirds of all bed days lost were down to the NHS, just over a quarter to social care organisations, and the rest attributable to both sectors.
Fifty-five percent of the respondents said the problem was worse now than a year ago, with many blaming cuts to social care budgets. They said it was:
• Leading to patients being put on wards inappropriate for their needs, such as a surgical ward for a medical patient.
• Forcing hospitals to open extra “contingency” or “escalation” wards.
• Making it harder to meet NHS waiting times for planned surgery.
• Wasting vital NHS resources on patients who no longer need them.
• Reducing elderly patients’ chances of being successfully rehabilitated.
• Lengthening patients’ stays, which the NHS has been trying for years to shorten.
Chris Hopson, the chief executive of NHS Providers, which represents NHS trusts, said the rising number of “delayed discharge” patients was leading to A&E units getting “jammed” with too many patients and urged ministers to increase funding for social care to solve the problem.
“Our members tell us delayed discharges are a very significant problem and a major contributor to current performance difficulties in accident and emergency services. You get what you pay for, and you cannot reduce social care funding without significantly increasing risk for the NHS, however hard local authorities work. The government has to properly fund both the NHS and social care to deal with rapidly rising levels of demand as the population lives longer and with increasing numbers of older patients with complex multiple conditions”, he added.
The charity Age UK criticised cuts to social care under the coalition for creating a system where vital NHS resources are wasted and patients suffer.
“We know that social care spending has fallen dramatically and that without social care older people are more likely to end up in A&E because of a health crisis. It is also clear that without the proper social care to support them stays in hospital are often longer than they need to be,” said Caroline Abrahams, the charity’s director.
“Waiting in hospital for care to be organised not only undermines an older person’s chances of recovery, it is also profoundly upsetting for them and their families. It is madness to waste expensive NHS resources in this way when it would be much more cost effective and better for older people to ensure good social care is available for them instead.”
David Cameron has blamed demand for the problems, saying an ageing population increased the pressure on A&E when they should be treated elsewhere. But the figures suggest that systematic problems are contributing to the strain on hospitals. The non-emergency NHS 111 helpline has also come under scrutiny for referring more people to hospitals.
Claims last year by Bruce Keogh, medical director of NHS England, that 40% of patients at A&E do not need urgent treatment, were afterwards disputed by the College of Emergency Medicine, which suggested only 15% could have been seen by a GP in the community.
Kevin Reynard, the college’s vice-president, said: “The issue isn’t, on the whole, getting healthy patients out of hospital. It’s people who have got clinical illnesses and clinical dependencies who need to go into some intermediate care or [are] waiting for social care or other community-based care.
“The squeeze in getting these services provided in a timely way makes it harder for us.”
David Pearson, president of the Association of Directors of Adult Social Services, said the number of older people with multiple long-term health conditions had increased exponentially while social services budgets had been cut by 26% over the last four years. “We have had to reduce the number of people receiving services by something in the order of 500,000.
“We have about 1.3 million people served by 1.5 million people in social care. This shows the level of need we are dealing with. There needs to be significant investment in community-based health and social care in order to care for more people at home.”
British Medical Association chair Mark Porter said: “It’s incredible, one in three people who were receiving state-funded care are not receiving it today and that sort of thing ripples back.”
Chris Ham, chief executive of the Kings’ Fund thinktank, said the system was “fundamentally broken” and there was no obvious cure. “We know some of it is due to increasingly constrained social care services but we also know most of the cases are within the NHS, because of a lack of coordination within the NHS itself, for example between hospital and community nursing staff.”
However, Care England, which represents care homes, said the problems lay with poor NHS management. Martin Green OBE, its chief executive, said: “For a number of years, independent care home providers have been offering the NHS increased capacity, in order to deal with the pressures that the health service faces over the winter months.
“These offers have been repeatedly ignored and it is no surprise that A&Es once again find themselves overstretched.
“A broken payment model, in which money flows into the acute sector at the expense of the rest of the health and social care system, has allowed the needs of individuals with complex conditions to escalate to the point at which they have no choice but to present at A&E.”There were also warnings that the crisis might see an increase in patients taking legal action.
Inez Brown, a medical negligence lawyer at Medical Accident Group, said: “Many hospitals simply can’t cope with the demand on their services, and now we’re about to enter the flu season when hospitals historically see a spike in patient numbers, the situation could get a lot worse.
“With so many hospitals declaring major incidents at the same time mistakes will be made.”