How the NHS winter beds crisis is hitting patient care

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By Josh Holder

NHS hospitals were forced to add over 5,000 extra beds in one day this winter — that affects the care patients receive

The winter crisis reached a new peak last week as NHS trusts had to provide 5,075 extra beds on 2 January to cope with demand, the equivalent of nine average hospitals.

According to a recent study by the British Medical Association, a lack of available beds creates a backlog that often leads to severe delays in emergency departments.

Analysis of official NHS data suggests the same knock-on effect this winter, with a greater proportion of ambulances delayed on days hospitals are forced to open more “escalation beds” to cope with increasing admissions.

Official NHS ‘occupancy rates’ fail to demonstrate the real level of overcrowding in hospitals this winter

According to official data, between 92% and 99.9% of beds have been occupied at the University Hospitals of North Midlands trust this winter, yet even these alarming figures mask the true scale of the pressure that hospitals are facing.

The trust has had more patients than core beds every day this winter, with the increased capacity coming from escalation beds – extra beds brought in on temporary wards to cope with demand. It has had to provide 4,737 bed days – one escalation bed used for one day – more than any other trust in the country.

Emergency medicine consultant Richard Fawcett said his department was closed to ambulances, having “run out of corridor space”, leading to “third world” conditions.

These problems are not unique to one trust, this is the story across the NHS this winter. Here are the next five worst affected trusts

Walsall healthcare trust in the West Midlands is also among the worst affected, operating at 100% capacity for 38 out of 49 days so far this winter, despite adding over 2,700 extra bed days.

An emergency medicine consultant told the British Medical Association of the “impossible” situation faced by staff who were “at the end of their tethers” at a Midlands hospital.

“The corridor into the hospital was so busy we couldn’t have got a cardiac arrest patient through it into the resuscitation room.

“There were people in our corridors for eight hours before we could see them.”

Hospitals opened the equivalent of nine extra hospitals some days this winter

The winter crisis reached its peak on 2 January with trusts requiring 5,075 extra beds in a order to cope with demand, equivalent to more than nine average-sized hospitals.

This is an increase on the the same time period in 2016, supporting claims that the NHS is facing its worst crisis in years.

“We are seeing conditions that people have not experienced in their working lives,”according to Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

This has a knock-on effect for patient care. As hospitals open escalation beds, the percentage of ambulances that are delayed rises dramatically

Analysis of official NHS data suggests a relationship between the number of escalation beds open across the country and the percentage of ambulances that are delayed by at least 30 minutes, leaving patients stuck in the back of ambulances waiting to be admitted to A&E.

This corresponds with findings by the BMA last year that bed pressures can cause delays to both patients waiting to be seen and so-called “trolley waits”, when patients have been seen but have to wait for a bed to become available before being admitted.

At the peak of demand on 2 January there were 5,075 escalation beds required across all trusts and almost a quarter of all ambulances were delayed by 30 minutes or more. Compare that to a day in late November, when only 9% of ambulances were delayed and 1,957 extra beds provided.

Medical experts agree that high levels of bed occupancy lead to more frequent bed transfers, and a greater risk of patients acquiring infections such as MRSA, or ending up on wards inappropriate for their condition.

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