‘Every day’ Greater Manchester hospitals are packed with 1,000 patients who are medically allowed to be discharged but cannot be, NHS bosses have revealed. Coupled with high numbers of people in hospital beds with Covid-19, hospital bed numbers are being perilously squeezed, they warn.
The figures come as NHS bosses admit that ‘all parts of the health and care system are under significant pressure’ as it heads into its most challenging period of the year - winter. Greater Manchester health chiefs say they are spending millions on trying to discharge people from hospital before a cold snap begins.
The Manchester Evening News has previously reported that, over the course of the last year, the region’s NHS has regularly experienced this level of patients well enough to go home, but unable to be discharged. As they wait to go home, NHS medics tell the M.E.N. patients are likely to deteriorate in other ways, making them more likely to have to come back into hospital in future and creating a revolving door of admissions.
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“We know that on any given day, we have around 1,000 in a hospital bed who are ready to go home. And for one reason or another, those patients do not go home on the day that they are ready to go home,” Steve Dixon, the chief delivery officer for Greater Manchester NHS, told a joint health scrutiny committee on Wednesday (November 9).
“There is a significant amount of work and effort around discharge and flow, that includes working with social care, voluntary sector, families, working with the care home and domiciliary care - but a main focus on discharge and flow.
“At the same time as seeing, treating and caring for people with their urgent pressures, we are still trying to maintain and clear the waiting lists and the backlog at the same time. Underpinning all of this is the challenge around workforce and the number of vacancies that we’ve currently got across health and care."
For months, the figure of patients ready to be discharged has stood at around one-fifth of all the beds in Greater Manchester - hovering from the late hundreds to 1,000 out of a rough total of 5,000 , according to a senior NHS source.
Patients are left in scarce hospital beds as they wait for even harder to come by spaces in social care. The sector is chronically understaffed, meaning that there are often not enough carers to give patients the support they need in moving back home.
There are also not enough care home beds for people to move into from hospital. Patients are therefore unable to move out of hospital, either to their own home or to a care facility, because the lack of social care staff means discharge cannot be done safely.
While they wait to be discharged, patients will often ‘decondition’, NHS sources tell the M.E.N. Often the older, more frail patients will deteriorate as they move less while in hospital, reducing their fitness and muscle tone through lack of exercise.
This can lead to other medical problems rearing up, leaving patients in a worse place than when they were admitted in some aspects of their overall health. The reduction in their functional ability can pave the way for yet more complicated medical issues needing treatment, and at worse more emergency department visits and resulting hospital bed admissions.
Meanwhile, precious beds are also now being occupied by a significant number of Covid patients - a medical problem which ‘didn’t exist three years ago’, again creating demand on a system which was already under strain before the pandemic, according to medical union leaders.
Currently, ‘eight to nine per cent’ of Greater Manchester’s hospital beds are occupied with patients with Covid, translating to roughly 400 to 500 beds, Mr Dixon continued.
“I think the public knows about social care being an issue, but if effectively 10 per cent of our hospital [beds] are working on people with Covid - something which didn’t exist three years ago so those beds could have been doing elective procedures - that’s quite shocking really,” Bury’s Councillor Elizabeth Fitzgerald told the scrutiny committee.
The NHS in Greater Manchester has been plagued by high bed occupancy for more than a year now. The chief delivery officer announced ‘around £13m to secure additional hospital beds’ in emergency funding in an attempt to create space this winter. “This is looking at all of the space we might have in our hospitals and keeping as many beds open as possible,” he explained.
But medics inside the NHS, who wish to remain anonymous, tell the Manchester Evening News that these additional beds will not be met with any additional staff to cope with the influx of patients. The unprecedented demand is already stretching staff numbers thin and additional beds will only create more delays in care, they claim.
In an outcry for more staff this time last year, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The NHS had widespread workforce shortages before the pandemic and these are at the root of the problems currently facing the NHS. The NHS continues to manage the biggest health crisis in its history while tackling an elective care backlog and managing a rise in demand for hospital services, all set against the backdrop of a decade of under-resourcing. Staff are spread more and more thinly, and it isn’t sustainable.”
The demand shows no sign of stopping, however, as the incoming cold weather will likely bring more patients in need of treatment for seasonal illnesses. The region’s NHS could see its ‘flexibility’ wear even further.
“[Covid] hasn’t gone away, we know once we get to more than 10 per cent of our beds occupied [with Covid patients], we really struggle because that flexibility starts to go, the ability to have beds ringfenced for our elective and planned work starts to degrade as well,” said Silas Nicholls, chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust and a coordinator of Greater Manchester’s urgent care and post-Covid response.
“There is something about trying to strike the right balance with the public, because everyone wants to have a good time and go back to normal. But there is something about remembering the basics around hygiene and infection prevention control, it is really important.”
“We’ve probably normalised the level of busyness we’re all under, and we’ve almost accepted it as the normal,” added Mr Dixon. “We shouldn’t. We do need to keep reinforcing the message that the whole health and care system is really busy, Covid has not gone away.
“The vaccination programme is the first line of defence.”
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