An NHS trust has launched a formal inquiry after an 89-year-old woman who was medically fit to leave hospital was trapped on a ward for six months, costing the NHS more than £80,000.
Iris Sibley and her family were left feeling “distressed and let down” after she was kept isolated on a hospital ward at Bristol Royal infirmary because the community healthcare provider failed to find her a suitable nursing home place.
The situation put a huge strain on the family and left her 90-year-old husband deeply unhappy, said her son John Sibley. “It’s pretty scandalous,” he said. “It’s not until you get caught up in it that you realise how serious the situation is. I decided to speak out about it because I wanted to stand up for ordinary people like my mum.”
In a case which highlights the deepening social care crisis in the UK, Iris was taken into hospital last June after a fall in her residential home. She was assessed by Bristol Community Health (BCH) on behalf of the South Gloucestershire clinical commissioning group, the NHS body responsible for local healthcare services.
On 11 August, BCH said she needed 24-hour nursing care, which would be covered by the NHS – but a place in a suitable nursing home was only found on 4 January this year, a few weeks after the agencies involved had been contacted by the Guardian for comment about the case.
Her son John Sibley said: “It’s pretty scandalous. It’s not until you get caught up in it that you realise how serious the situation is. I decided to speak out about it because I wanted to stand up for ordinary people like my mum.”
Sibley said the staff who looked after his mother were amazing. “They just don’t stop, they are always working – nothing is too much trouble for them. I call them angels and they are – but they shouldn’t have to do it,” he said.
The family were offered two places, one on 13 September and the other on 4 October, but both were too far for Iris’s husband to visit. The first was also a very poor choice, said Sibley. “I read the CQC report and it was appalling, and when I visited it I thought I wouldn’t put a sick dog in there let alone my mum. It smelt of urine, the paper was peeling off the wall in the room they wanted to put her in. It was disgusting.”
To make matters worse, Iris was diagnosed as being a carrier of C diff, a bacterium that can cause diarrhoea, so spent much of her time alone in a side room. Sibley said the family constantly had to chase for information about her future. According to BCH, the ongoing health team “actively communicated” with the family on nine occasions.
Iris’s physical and mental health deteriorated significantly, Sibley said. “She was mixing with other people [in the residential home], it stretched her mind a bit,” he said. “But in the hospital there is nothing. They are wonderful people, they do the best they can – but my mum was in a hospital, not in a place where she could call home.”
That was very common in older people whose discharge from hospital was delayed, said Caroline Abrahams, the charity director at Age UK. “People in hospital lose confidence, they lose muscle mass. Their families can see their situation deteriorating before their eyes and that is very distressing,” she said.
Robert Woolley, the chief executive of University Hospitals Bristol NHS foundation trust, said it had launched a formal investigation into the case.
Iris’s protracted hospitalisation – which her family described as “traumatic for all concerned” – cost the NHS £450 a night, approximately £81,000 in total.
Although her experience is extreme, it is not unusual. In a typical week in January, 60 patients at Bristol Royal infirmary were “green to go”, waiting for an assessment or care package for about three weeks. Patients who could not be discharged could result in medical patients occupying surgical beds and surgeries cancelled, said Woolley.
“I’m very sorry for what happened to Mrs Sibley and apologise to her family for the massive frustration that all of us have caused,” Woolley said. “There is a critical interdependency between social care and the NHS and, if we get the capacity wrong in social care, it’s the NHS that bears the consequences, that is plain for all to see.
“We are doing everything we can to deal with a constant and growing demand. I think it is very difficult and we are having to look at more and more radical ways to cope with the pressure.”
BCH, which was charged with finding Iris a nursing home place, said it had contacted 24 homes “sometimes multiple times”. Of these, 11 had no vacancies, 11 were not able to meet Iris’s needs and two were too far away. All were privately run.
Iris’s case was unusual, said chief executive Julia Clarke, BCH’s chief executive. “In Mrs Sibley’s case, we are really sorry she was in hospital for that length of time – it is not what we were working towards,” she said. After an internal investigation, BCH was reviewing its communication with patients and had changed its processes so individual cases were flagged to senior leaders after a few weeks.
Anne Morris, the director of nursing at South Gloucestershire CCG, said Iris’s case was under review and it was “extremely sorry when any patient is kept in hospital any longer than they need to be”.
The Department of Health said it had published guidelines to improve coordination between the NHS and councils and was working with all agencies to improve the transfer of patients from hospitals. A spokesperson said: “We are supporting councils with up to £7.6bn of dedicated funding for social care over the course of this parliament.”
If this is how bad it is now, what is it going to be like in another 20 years’ time?
Iris has since been reassessed and her family has been told she no longer qualifies for complete NHS funding. Her care will be funded by the council, but the family – who are appealing against the decision – may face top-up payments.
According to a joint King’s Fund and Nuffield Trust report published in September, about four in 10 people pay for their own social care, with 300,000 fewer people receiving council-funded help than four years ago. According to Age UK, 1.2 million people do not get the social care they need, up 48% since 2010.
The Local Government Association (LGA) estimates the social care funding gap will be about £4bn by the end of the decade, leaving council short by a thirdCllr Izzi Seccombe, who chairs the LGA’s community wellbeing board, said: “The scale of underfunding is placing the care provider market under huge pressure, making it more difficult to discharge people from hospital into care.”
More than 100 care home businesses have collapsed since 2010, and more are struggling after councils’ social care budgets were slashed by up to 50% as the government pressed on with austerity measures.
People who pay for their own care pay more than a local authority for an identical care home placement, which, said Sibley, was leaving people like his mother at the bottom of the pile. “As result, my dear old mum who I love to bits was stuck in a hospital for six months with her dementia getting worse and worse,” he said.
“I don’t want to make this political, but this is a problem that has been waiting to happen for 25 years. Government after government have put their head in the sand. But now we have to make a decision: if this is how bad it is now, what is it going to be like in another 20 years’ time?”
Woman, 89, trapped in hospital for six months despite being fit to leave
