Waiting Lists And Discharges - Does The NHS Need More Beds?

5.2.07

1997: impending crisis
• 1,132,200 patients on waiting lists for hospital admission.
• 30,000 patients waiting for >1 year.

What causes waiting lists?
• Under-funding.
• Rationing.
• Inefficiency.
• Vested interests.

Waiting pools, not lists
• Treatment pool.
• Assessment pool.
• Not referred pool.

1997 political focus on waiting lists.

Cancer plan 1997
• Fast track referrals.
• Maximum 2-week wait.
-Breast cancer by April 1999.
-All other cancers by 2001.

March 2000
• 100,000 reduction achieved.
• 18-month waits virtually eliminated.
• 50,000 waiting 12 months.
• 130,000 waiting >26 weeks.

NHS plan 2000
• Outpatient:
-Maximum wait reduced from 6 to 3 months.
-Average wait 5 months.
• Inpatient:
-Maximum wait reduced from 18 to 6 months.
-Average wait 5 months.

National Beds Enquiry 2000
• Numbers and distribution of beds.
• Factors determining usage of beds.
• 66% beds occupied by patients >65.
• Traditional role of NHS:
-Managing life's incidents.
-Acute care.
• Ageing population:
-Increased chronic disease.
-Proactive and ongoing care.

The response
• Accelerating discharge:
-Reform of hospital organisation.
-Support in the community.
• Reducing admissions.
-Alternative treatments.
-Support in the community.

• Absence of alternatives to acute care contributory factor to all categories of delay.

Delayed discharge from hospital
• Symptom and cause of:
-Poor bed management.
-Failure of communication between health and social care.

Problems with hospital discharge
• Delayed.
• Occurs too soon.
• Poorly-managed from patient/carer perspective.
• Transfer to unsafe environments.

Causes of delayed discharge
• Internal hospital factors:
-Timing of ward rounds.
-Waits for results.
-Delay in home assessment.
-Organisation of medication.
-Availability of transport.
• Coordination issues:
-Health services.
-Social care services.
-Other community services.
• Capacity and resource issues:
-Availability of rehabilitation places.
-Placement difficulty with care homes.
-Availability of home care provider.
• Patient/carer involvement:
-Failure to involve in decision-making.
-Limited choice of care options.

Improving discharge performance
• Discharge = process, not isolated event.
• Transfer from hospital to appropriate setting needs careful planning.
• Discharge planning should start before elective admissions and ASAP after emergency admissions.
• Patients and carers should be involved at all stages.

Improving services for vulnerable people

Intermediate care
• Range of integrated services to:
-Promote faster recovery from illness.
-Support timely discharge.
• In Liverpool:
-Emergency Response Team (ERT).
-Intermediate care team.
-ACTRITE (A+E assessment of COPD patients).
-Tracker nurses.
-Orthopaedic rehabilitation at home.

Patient journey through illness
• Many people fear experience of hospitalisation and loss of autonomy.
• Want to return to living normal lives ASAP: every effort should be made to help them do so.
• Acute hospitals should only be used for delivery of services that cannot be provided as effectively in home/social setting/community