British Medical Association call for action on "bed blocking"

The number of days patients are spending in hospitals due to so-called “bed blocking” is at its second-highest figure on record.

New data for England has revealed that people occupying beds when they no longer needed care took up a total of 171,298 days in June. It marks a considerable rise of more than 30,000 days on June 2015, during which 139,538 days were taken up by the delays. But NHS England said that, although the figure was still “significant”, it had decreased on the previous month, when it hit a record high.

Related: NHS hospitals face record levels of ‘bed blocking’

Bed blocking occurs when someone is medically fit to be discharged, but care has not yet been organised to help them outside of hospital. The British Medical Association said that the issue – which largely affects the elderly – urgently needs addressing.

Council chairman Dr Mark Porter said: “Problems at the hospital front door are linked to delays at the back door. This is because a shortage of social care beds creates ‘exit block’ in hospitals, meaning patients who no longer need to be in hospital can’t be discharged because there is simply nowhere for them to go.

“This, together with a shortage of beds and a shortage of doctors, leads to delays in admissions and patients being forced to wait on trolleys or admitted to an inappropriate ward.”

More than half (59%) of delays were due to the NHS, while the social care sector were responsible for 32% of the delays. Both were responsible for 7.9%, the report said.

An NHS England spokesman said: “Thanks to tremendous efforts by the NHS and social care, the number of delayed transfers of care stopped increasing in June, although there were still a significant number of patients waiting for discharge from hospital.

Related: Delays in discharging older patients from hospital ‘cost NHS £820m a year’

“It’s important patients who are well enough to leave hospital can do so at the earliest opportunity, and in some parts of the country the system is working well. These figures underline the importance of joined-up care within the NHS and the dependence of hospitals on well-functioning social care services – particularly for older people living at home.”

Figures also show that major hospitals in England are failing to see almost one in seven patients within four hours, as medics warn that emergency staffing has reached crisis levels.

New statistics for June reveal that nearly 15% of people in larger A&E departments and almost 10% of people in all hospitals are not discharged within what is considered the expected time. The target of seeing 95% of patients within four hours has not been hit by an A&E at any major hospital since July 2013.

It comes the day after the Royal College of Emergency Medicine warned that a gap between supply and demand for emergency doctors is leading to a “real crisis”.

NHS England defended the figures, saying they showed “another improvement in performance” at a time when “frontline services continue to come under intense pressure”.

Related: Scottish hospitals miss key A&E waiting times and bed blocking targets

But a number of other key targets were also missed by the health service – including on ambulance response times and cancer waiting times. Hospitals across the country have been blighted by disrupted services in the wake of funding cuts. A national shortage of emergency doctors also led the Grantham and District Hospital in the East Midlands to announce it was to temporarily close its doors at night.

St Helens Clinical Commissioning Group caused outcry after suggesting financial demands could lead it to ban all non-vital operations for four months.

The Department of Health said that despite shortages in specific A&Es, there were 1,250 extra doctors working in emergency departments compared with 2010. A spokesman said: “The NHS had its busiest June ever but hospitals are performing well, with nine out of 10 people seen in A&E within four hours – almost 60,000 people per day seen within the standard.”

British Medical Association call for action on "bed blocking"

Social care difficulties lead to hospital bed blocking, says Age Uk

‘Deepening troubles in social care mean patients can’t be discharged, according to new investigation.’ Photograph: Photofusion/Rex

Practically 2m bed days in hospitals have been wasted since 2010 because deepening difficulties in social care imply patients can not be discharged, in accordance to new study.

Some elderly patients are currently being trapped in hospital for up to thirty days – a day longer than 4 years ago, on regular – whilst waiting to be transferred to a residential property, despite getting match to depart.

An estimated total of one,928,255 bed days have been misplaced to the NHS in England considering that 2010, at a value of £526m, at a time when hospitals have been under increasing pressures, in accordance to Age Uk.

Drawing on official publications, the charity showed that the average wait faced by a patient needing grab rails or ramps fitted at property has risen by eleven.five% to 27.three days, while a social care bundle now requires 28.six days to be arranged, 5% longer than in 2010.

The lengthening delays have occurred at a time when neighborhood councils have reduce £1.2bn from their social care budgets and the eligibility criteria for assistance have been tightened so support is offered to fewer folks, despite the ageing population.

“This marked rise because 2010 in the length of time individuals are currently being forced to linger in hospital since of a delayed assessment, care property area, property care package deal or house adaptation is an final result of the crisis in social care”, explained Caroline Abrahams, Age UK’s charity director. “It is crazy to waste high-priced NHS resources in this way.”

A bed in an NHS hospital fees about £1,900-a-week compared with £530 generally charged by residential homes.

Social care difficulties lead to hospital bed blocking, says Age Uk

Who is blocking adjust in the NHS?

David Nicholson envisages centralisation of expert solutions and emergency care. Photograph: David Levene

In his final days as NHS England chief executive, Sir David Nicholson has warned that the wellness support is doomed to long-phrase decline unless it reforms comprehensively and quickly. So who is blocking adjust and what ought to occur to them?

In an interview final week with the Guardian’s Denis Campbell, Nicholson argued that it requires “massive adjust, on a scale we’ve in no way observed just before, and above a shorter period of time than we’ve ever seen ahead of in healthcare”.

He envisages enormous centralisation of professional solutions and emergency care, alongside considerable expansion of main and community care and far closer co-operation amongst clinicians inside and outdoors hospitals. However across the NHS, effective, poorly co-ordinated elements of the system are obstructing alter. Foundation trusts (FT), terrified of exposure by Check or the Care Top quality Commission, are a lot more centered on becoming inspected and regulated than they are on working with clinical commissioners to reform the local well being economic system. CQC inspectors routinely will not even bother talking to commissioners just before inspecting a provider, demonstrating a worrying lack of curiosity about what solutions appear like to the men and women buying them.

Meanwhile, the NHS Believe in Improvement Authority (TDA) continues its doomed, endlessly postponed mission to flip each provider into an FT. Even Nicholson now admits that will not function. (There are comical differences in tone among Keep track of and the TDA: the former is sparse and business-like the latter uses simple, patronising sentences which imply that if you can not get a occupation in an FT you have to be a bit thick.)

There are parallel languages getting spoken in the NHS. One is the language of transformation, innovation and threat-taking. The other is of regulation and compliance. Commissioners and providers complain that while they are advised to innovate and modify, rigid oversight regimes see no want to adapt to local priorities.

There are also few managers striving to do also considerably. Bureaucratic systems such as competitors law and compliance have to be fed ensuring a seamless patient knowledge is a reduce priority.

Clinical commissioning groups are starting up to make a difference in enhancing pathways and high quality but they are struggling to secure significant service transformations across areas. At least NHS England, regardless of atavistic spasms of centralisation like the recent money grab from CCGs poorly disguised as “risk pooling”, is exhibiting signs of comforting its grip and encouraging innovation. It seems open-minded to nearby variations in the Payments by Benefits regime in the interests of focusing on outcomes and moving care into communities, and it has acquired the message that securing a considerable growth of care outside hospitals calls for CCGs to take a major position in creating main care.

Such little indications of motion are welcome, but they do not come near to delivering the scale or speed of change essential to make certain a sustainable, substantial-quality overall health service.

If the NHS leadership is significant about delivering big-scale adjust, it demands to commence living its very own rhetoric and taking hazards. Regulation and compliance regimes must be stripped back to essentials and built about a unified see of what constitutes accomplishment, whilst as significantly management capacity as feasible must be redirected from administration and oversight into major modify.

CCGs should crew up more properly and operate much more strategically across larger places to deliver reconfigurations.

Above all, the NHS requirements a coherent economic approach. The slow death of the payment by final results technique must be accelerated urgently, the drive in the direction of universal FT status must be abandoned, and the descent of rising numbers of providers into debt should be a reason for urgent action, not viewing and dithering.

If hard selections need to have to be taken about shutting services and hospitals, then the men and women responsible ought to both battle for individuals decisions or hand above to someone who will. The politics will be explosive but if closures are required then the men and women who believe that must make the situation to the public. Saying that it is all also hard is not an answer.

This write-up is published by Guardian Expert. Join the Healthcare Professionals Network to obtain typical emails and unique offers.

Who is blocking adjust in the NHS?

David Cameron: Blocking blanket NHS pay out rise will assist hospitals

Ministers stated that stated that proposals to give overall health employees a blanket one per cent pay rise, as suggested by an independent shell out overview physique, would price nearly half a billion pounds – equivalent to the salary of 14,000 new nurses.

Increases of one per cent will be provided to some employees in the NHS, as properly as to members of the armed forces, medical doctors and dentists, senior civil servants, prison officers and the judiciary.

But an estimated 600,000 health employees will only acquire their standard incremental pay out rise rather than the one%, which had been recommended by a shell out assessment physique.Close to 400 “very senior managers” in the NHS will not get the one% rise.

The move implies that health staff encounter a fourth yr of below-inflation increases and sparked anger from unions.

Unison accused the coalition of taking a scalpel to the pay assessment report and of “showing contempt” for NHS employees, adding that 70% of nurses will get no pay out rise this 12 months.

The GMB said it will now consult its members in the NHS on what they desired to do, warning that the blocking of a total 1% pay out rise would be taken as a “private insult”.

Nevertheless, speaking during a trip to the Middle East, Mr Cameron explained: “Let us look at the large picture right here. It is correct to make difficult selections about public sector pay out because it indicates we can maintain a lot more men and women employed, we can keep much more folks in perform and make certain we devote funds on crucial remedies, on hospitals, on delivering companies which is what patients so badly want.”

David Cameron: Blocking blanket NHS pay out rise will assist hospitals

NHS hospitals encounter record ranges of "bed blocking"

Hospitals are facing increasing “bed blocking” as they consider to deal with an boost in the quantity of patients needing to be admitted as emergencies this winter.

New NHS figures show the total quantity of bed days misplaced since of “delayed transfers of care” – generally induced because social care assistance is not offered to let a fit patient to return property – hit 70,124 final month, the highest December total because the NHS commenced recording the figures in 2010.

The 162,728 delayed discharges so far this winter are nicely up on final winter’s 135,368 equivalent.

Dame Barbara Hakin, deputy chief executive of NHS England, said it was “concerning” that the 103,071 sufferers admitted as emergencies final week was seven,781 higher than at the very same time the yr before and 1,259 up week-on-week.

While the number of cancelled operations fell week-on-week to 1,126, a total of 12,445 have currently been cancelled this winter, up one,220 on the 11,225 seen in the equivalent period twelve months ahead of.

Andrew Gwynne, the shadow wellness minister, said the figures have been “really sad and a direct end result of this government’s brutal cuts to social care”. He mentioned: “Ministers left folks with no the residence care they need and numerous flip to hospital for support. Hospitals are now complete to bursting and sufferers are suffering the unacceptable anguish of having their operation cancelled.”

NHS hospitals encounter record ranges of "bed blocking"