The Royal College of Emergency Medicine (RCEM) has argued that to free up beds to speed the flow of patients through Emergency Departments and empty hospital corridors of stranded patients would require a drive to discharge 60% of the patients who have been assessed as medically fit, and with ‘no criteria to reside’ in an acute bed.
According to NHS England figures, during November hospitals began each day with an average of more than one in five (over 20,000) front line General and Acute (G&A) beds filled with patients who had had ‘no criteria to remain’ in an acute bed, and should have been discharged.
These lengths of stay are well above average, and it’s far from clear that all of these patients are best cared for in busy acute wards.
The NHS figures for patients “who no longer meet criteria to reside” line up with the RCEM estimates, with the latest figures (up to January 4) showing numbers fit for discharge generally well above 20,000 on weekdays and slightly lower over weekends, but numbers of discharges far lower, leaving an average of 12-13,000 people, who should have been discharged, still occupying vital beds.
On Friday, 28 November, for example, the England average was that 51% of patients with “no criteria to reside” remained in hospital, while only 49% were discharged. More than half (24 out of 42) of Integrated Care Systems had between 50 and 74% of patients still occupying beds.
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Hospital trusts vary widely in the problems they face in discharging patients: so for November 28 the total of 13,300 patients who could not be discharged meant more than one in ten (14%) of the trusts that reported numbers had more than 200 beds filled with patients who should have been supported elsewhere, with three of these (Liverpool University Hospitals, Portsmouth Hospitals and University Hospital Sussex) topping 300.
Measuring by percentages of patients who could not be discharged, the biggest problems are faced by Northern Care Alliance hospitals in the North West (94%); East Cheshire (93%); and three more trusts over 80% (York and Scarborough; Northampton General; and Epsom and St Helier in South West London).
But it also seems that the longer a patient has been in hospital, the harder it is to discharge them. On the same Friday November 28, of 7,532 patients across England with a stay of over 21 days, just 14% (1034) were discharged, giving an average of 86% (6,498) still in an acute bed. Only five of the 42 Integrated Care Systems discharged more than 20% of the 21-day plus patients who were theoretically ready to go, and only one (Mid and South Essex) managed to discharge more than half (51%).
This seems to be the sticking point. To be in hospital so long implies patients who are frail and need substantial support to live safely outside of hospital.
But neither social care nor community health services are funded or organised to take on these patients. And as long as that remains the case, hospitals will need more beds (real beds, not imaginary ones) to ensure the sickest emergency patients are not lining their corridors, storerooms and clinic spaces by 2029.
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