The Urgent and Emergency Care Situation Reports (Sitreps) published by NHS England show that for the week 12-18 February the average daily acute bed occupancy stood at 95.5%. This is a further increase from the average 94.7% occupancy a week earlier, and higher than the highest suggested target level of occupancy.
The Royal College of Emergency Medicine (RCEM) calculates that based on the latest figures “an additional 11,828 available beds would have been required to bring bed occupancy down to the level considered to be ‘safe’ (85%) in General and Acute care.”
These are the latest revelations as the RCEM continues its excellent, but sadly single-handed fight to focus attention on the continued excessive strain on emergency services and hospital capacity.
Despite some earlier signs that perhaps the levels of demand might prove lower this winter than the disastrous pressures a year ago, RCEM Vice President Dr Ian Higginson said:
“There is no respite in sight, with acute and general care bed occupancy at dangerously high levels. Our departments remain seriously overcrowded. The government cannot continue to ignore the reality that our patients experience and which these data represent. What will it take for them to acknowledge the issues? The silence is deafening. The inaction is verging on negligent.”
He warns that there is still an expectation that emergency medicine doctors, nurses and other staff will be there for those in need: but this leaves staff in emergency care trying to make a broken system work. “They are under resourced, often working under impossible conditions.”
And as another extended strike by junior doctors looms, the RCEM emphasises that the dire situation is not the fault of strikers, but politicians:
“The government must not try to blame the problems in the urgent care system on strikes. This crisis is caused by years of poor policy decisions leading to under-funding, lack of staff, lack of beds, and inadequate community and social care.”
According to 2018 guidance from NICE (National Institute for Health and Care Excellence) the notion of 85% occupancy as the norm for safe running of hospitals seems to have originated with the National Audit Office. The NAO suggested that hospitals with average bed occupancy levels above 85% should expect to have regular bed shortages, periodic bed crises and increased numbers of health care-acquired infections.
That’s why the 85% target is still upheld by the RCEM, even though NHS England, faced with bed occupancy percentages soaring into the 90s, increased the ‘norm’ to 92%.
Now the New Hospitals Programme team, which initially adopted an even higher 95% target occupancy for the (as yet imaginary) 40 new hospitals, has reportedly eased back to the 92% NHS England norm.
But in the real hospitals even to reduce current occupancy to 92% would require an extra 3,100 general and acute (G&A) beds.
Without fixing the broken system, to ensure patients ready to leave hospital can be properly cared for at home or in care homes or community health services, no amount of extra beds will be enough.
The latest figures show a daily average of 18,969 patients who had occupied a bed for 21 or more days – meaning 18 percent of England’s acute bed capacity is tied up – in addition to the numbers filled with flu and Covid patients. Upwards of 13,000 patients per day on average “no longer meet the criteria to reside” in a hospital bed, but cannot be discharged because the system is broken.
Without patients being discharged to make beds available, the delays in emergency services fall with greatest impact on those in most serious need of care, while more minor cases are inconvenienced.
No matter how hard they try, hospital staff can’t solve these problems or get the system moving without an injection of staff and resources, coupled with a long-overdue reform of privatised and chaotic social care services.
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