Bed shortage piles pressure on hospital staff

'Each day, we have a complete mismatch between the patients we admit and the number of patients we discharge'

Sunday, 13th February — By Tom Foot

Royal Free

Royal Free Hospital

DOCTOR shortages and unprecedented demand on an under-resourced emergency departments have left staff “doing things none of us are comfortable with”, according to a Royal Free board chief.

Debbie Sanders told a Royal Free London board meeting last week that “staff were working incredibly hard to make it [the A&E] safe for patients” at Barnet Hospital that was “completely full to our front door”.

But she said the NHS Trust was routinely operating a one-out-one-in system and that patients were being transferred to wards despite no beds being free for them.

To help ease demand on beds, managers are in the process of setting up a “virtual ward” where frail and elderly patients are cared for online at home instead of in the hospital.

Hospitals are buckling under pressure of huge surges in attendances at A&E, while also having to divert resources to undo a massive backlog of appointments that built up during the Covid crisis.

Ms Sanders said: “Each day, we have a complete mismatch between the patients we admit and the number of patients we discharge. Very rarely do we get a balance. We are completely full to our front door.”

She added: “Each morning we sort of have between 20-30 patients waiting for admission, and A&E is full with 32 patients also needing admission to the main hospital.

“We literally find ourselves operating on a one patient into hospital, one patient into ED [emergency department].

“We have had to do things none of us are comfortable with. We are doing something called ‘plus one-ing’, moving patients to a ward where there isn’t a bed for them but we know there will be one later in the day. I absolutely don’t want that to become business as usual.”

She added: “We are looking at a virtual ward. We had a Covid one and it worked well. We are starting to consider how we might do that for patients with delirium, and then moving to frail and older patients with an ambition to have 24 patients sitting under the care of consultants.”

Problems with ambulance transfers and lack of social care are causing havoc for patients waiting to be discharged from hospital.

Ms Sanders said managers were struggling with a “large number of medically optimised patients who we have done everything for and are just waiting to be discharged”.

“A significant number of those are waiting a number of days to be discharged,” she said.

“We are identifying golden patients who are ready to go in the morning. We have been impacted by reduced capacity in the community, in community beds and care home beds closure due to outbreaks or due to staff sickness, which has impacted on us internally.”

The NHS Trust was introducing more “lists” of shifts and hiring private firm Acacium to fill rotas on the weekends, according to Ms Sanders who added: “But again, our staff are tired, they don’t want to do extra work.”

NHS spend on private healthcare rose 27 per cent last year. More than 8,000 patients are waiting longer than a year for treatment following a referral from their GP, the meeting heard.

The problems at the Royal Free London are being experienced by hospitals across the capital.

UCLH’s chairwoman Julia Neuberger this week reported that the hospital in Euston had been affected too, adding: “The emergency department has been unusually pressured and very busy and unfortunately it continues to experience high levels of violence and aggression from relatives/ friends and patients.”

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