Several daily newspapers have, today, highlighted the delays in admitting patients to hospital from A&E because of a shortage of beds. This is leading to “hundreds of deaths per year” in the UK, the royal College of Emergency Medicine has warned.
In a new report on the growing problem 0f “exit block”, the RCEM said that for every department seeing 50,000 patients a year, exit block accounted for 13 deaths.
Extrapolated nationally, this level of mortality would suggest up to 3,800 people may have died as a consequence of exit block in England in the past year. Exit block increases the length of a patients stay in A&E and can delay critical interventions such as antibiotic administration and pain relief. It also means A&E stay at capacity for longer and cannot treat new arrivals, extending waiting times.
The causes of exit block are complicated, but the problem is exacerbated by delays at the “back door” of hospitals, where patients, usually the frail elderly, who are medically well but require long-term care often have to wait to be discharged into the community.
Around 1,000 avoidable deaths occur in the NHS in England each month. While not all deaths by exit block are necessarily avoidable, the RCEM sad any initiative to reduce mortality must also address exit block, which it said “accounts for hundreds of deaths per year”.
A Department of Health spokesman said its target was to cut the number of avoidable deaths in the NHS by half in the next three years.
“The situation in at least one A&E has been tackled by hiring a private firm to get people home. The hypocrisy of this is that the NHS is forking out a fortune for a private company to hire the care staff to get and keep people home, when it should be doing it ‘in house’ . It shows the state our NHS is in when getting people home through a third party is needed. The implications of this… well think about it.”
Care of the elderly is in a state of “calamitous, quite rapid decline”, a leading charity boss has warned, with hundreds of thousands fewer people receiving care than five years ago.
More than £1bn has been slashed from councils’ social-care budgets in England since 2010, despite an increase in the elderly population, meaning thousands who would have received help with basic tasks such as getting out of bed or taking medication no longer get support, AgeUK said.
Caroline Abrahams, it’s director, said the cuts were also harming the NHS, with hospitals struggling to discharge patients quickly into home or community care – a major factor behind the extreme pressure faced by hospitals this winter.
The problems of “exit block” leads to delays in admitting patients from emergency departments, because beds are taken up by frail elderly people waiting for a community-care package. It is believed to be a major factor contributing to this winters’ 10-year highs in A&E waiting times.
AgeUK said the number of older people receiving home care has fallen by a third since 2010, while places in day-care centres declined by two-thirds. More than 40 per cent fewer people receive equipment and adaptations such as rails and stairlifts.
Just under 9 per cent of over-65s – 850,000 people – receive any support from councils, down from well over a million five years ago.
The Department of Health, said that, in total, an extra £1bn had been given to local councils to help to protect social-care services this year, adding that councils were responsible for determining their own budgets.
The Government is to give £25m to 65 councils where delays in discharging elderly patients from hospitals are the most severe.
“The Department of Health puts back £1.1bn into c0unty councils when so much damage has already been done by savage cuts to funding. It’s a bit rich.”