Winter Crisis Woes

[box] Sadhana Kalidindi of the University of Bristol reports on growing concerns over the number of hospital beds available this winter [/box]

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It is widely feared that the NHS is on the brink of yet another winter crisis. The chief executives of King’s Fund, Nuffield Trust and Health Foundation have warned that crisis is inevitable even if the weather remains mild.

This week, 12 hospital Trusts revealed that the crisis was already well under way as they were unable to admit any more patients after running out of beds last weekend.

Nigel Edwards, Chief Executive of the Nuffield Trust said: “Given that there is no extra money for winter this year, hospitals are likely to find it even more difficult to cope in the coming months, especially as almost all Trusts are now in deficit.”

It is stressed that the problems in winter are not caused by more people turning up at A&E – – but admission rates are relatively high and, amongst other factors, there is a growth in people with breathing problems who need to spend longer in hospital. But the underlying cause is that bed occupancy is too high – often above 90% – so systems soon topple over as more patients are admitted.

One of the big problems contributing to the bed shortage seems to be social care cuts. Siva Anandaciva, head of analysis at NHS Providers, which represents hospitals, said that a key factor was that “heading into winter, demand and activity are up, and social-care cuts have started to bite, which influences both the number and severity of the patients the NHS is treating, and our ability to get these patients back to their homes and communities when they no longer need medical care.”

Official statistics show that the levels of “bedblocking” in the NHS reached a record high long before winter was underway, according to new figures. They show that the amount of time patients spent in hospital – when there was no medical reason for them to be there – was the highest ever recorded in October.

The patients taking up a third of the total bed capacity are likely to have been frail or elderly people who the system was not ready to return to their own homes or to nursing or residential homes, despite their medical treatment being finished.

There is also concern about changes in the way the statistics are reported. In previous winters, hospital performance statistics were made public every week.

But this year health officials will issue far more limited data – with figures on the number of ambulances queuing, cancelled operations and performance against four hour A&E targets subject to a six-week delay.

Overall, the perilous financial situation of most UK Trusts this year as well as the potential impact of social care cuts resulting in bed blocking is making a lot of people fear that we could be facing one of the worst winter crises ever unless urgent and substantial financial assistance is provided.

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