Consultant Describes A&E as a “Motorway Bottleneck” Amid Hospital Discharge Challenges

Healthcare leaders in Cheshire and Merseyside report difficulties in promptly admitting patients to hospitals due to a high number of existing inpatients who cannot be discharged. They assert that as many as 25% of patients, deemed medically ready for care at home or in an alternative setting, remain in hospital beyond necessity due to challenges in arranging community support. This region accounts for over a quarter of all hospitals nationwide presently receiving “urgent support” from NHS England to address this problem, which significantly affects Accident & Emergency departments. Gill Dummigan, BBC North West’s Health Correspondent, visited Macclesfield District General, one of the hospitals receiving assistance. At Macclesfield District General Hospital’s A&E department during mid-morning, the environment is calm yet focused. Emergency Department (ED) consultant Dr Tom Bartram stated, “It’s really busy. We are well above our capacity at the moment and the demand coming through the door is really high.” Dr. Bartram added, “At the moment I know that we are at about 150% of our bed base in ED. So not everyone’s in a clinical space as we would want them to be but we are caring for them none-the-less.” This means the emergency department is accommodating 50% more patients than its designated capacity, with six individuals receiving care in the corridor. Dr Bartram noted that this situation is now common. He remarked, “It’s really stressful, really emotive. Everyone here wants to do the best that they can. All the staff care profoundly about the patients, and the burden of trying to provide that care for every single patient here is really, really difficult for people.” Providing care in A&E corridors has become a regular occurrence in numerous acute hospitals, with certain larger facilities establishing complete wards within these passageways. The issue stems from the lack of available space for patients within the main hospital due to overcrowded wards. A substantial number of these ward patients could, hypothetically, be discharged if appropriate social and community care provisions were arranged for them – however, these are frequently absent. Consequently, the entire healthcare system becomes congested, funneling patients to the one department that cannot refuse admission – A&E. Dr Bartram likened the situation to a motorway bottleneck, stating, “If we can’t get people out of (A&E) and into hospital beds or back into the community where they need to be then we’re that funnel.” This issue is particularly pronounced in this region. Across the nation, NHS England has identified 19 hospitals requiring urgent assistance this year with A&E patient flow. Five of these – Whiston, the Countess of Chester, Macclesfield District General, Leighton, and Arrowe Park – are located in Cheshire and Merseyside. Blackpool Victoria brings the total to six in the North West. According to the Medical Director for NHS Cheshire and Merseyside, the primary challenge lies in safely discharging patients from hospital. Professor Rowan Pritchard Jones stated, “When I look across our entire system, up to a quarter of hospital beds have a patient in them who is well enough to be at home, but we are working really hard to organise that package of care to get them home.” The clear remedy involves enhancing the effectiveness of other services, especially community care. Since September, a dedicated team from NHS England has been consistently visiting each hospital to assess the collaboration among various components of the local health service. Additionally, a modest fund has been allocated to support new initiatives. Macclesfield currently operates a robust system designed to integrate various professionals, called the Transfer of Care Hub. Within a spacious room on the hospital premises, social workers, district nurses, and care co-ordinators are assembled at desks, continuously communicating by phone and amongst themselves to devise optimal patient care plans. Alison Crossley, a nursing sister at the hub, conducts daily morning ward rounds to assist in identifying patients who may be prepared for discharge. She explained, “We’ll then do all the assessments, liaise with the families, the carers and the patients themselves to make sure that we can get people out quickly into the right place so that they are safe and all their care needs are met.” Katie Andrew, a care community coach, highlighted the significant benefit of being able to utilize diverse teams for various support requirements. She elaborated, “They can have a chat with the social workers, with our hospital at home team, it might be that they might need the district nurse to just nip in overnight and have a look at the patient if it’s a late discharge. So we all work collectively together to make sure we can support the patient in the best way”. Other efforts are focused on offering additional assistance to prevent individuals, especially the elderly, from needing hospital admission initially. The East Cheshire Trust has trialed a program deploying nurses to care homes to educate staff on crucial health indicators, such as proper hydration, and on how to promptly address potential health issues before they escalate. They report that this initiative alone has resulted in a 20% reduction in A&E admissions from care homes over the last year. Furthermore, the latest NHS data indicates a significant decrease of 33% in the number of patients waiting 12 hours or longer for hospital admission compared to the previous month. However, there is a widespread understanding that the most challenging months are yet to arrive. Professor Rowan Pritchard Jones commented, “There is no doubt that there is a tough winter that is happening now, and it feels like we’ve got a storm of issues which are coming together.” The primary concern is the “quad-demic,” characterized by significant increases in cases of flu, norovirus, and the respiratory condition RSV, alongside an anticipated rise in Covid. He noted that vaccination rates remain insufficient. He urged, “Please get your jab, please make use of the different services out there, whether that’s your own GP practice or 111, and come to A&E only if you really need to but (in an emergency) the A&E is open and ready to care.” For more content, listeners can tune into the best of BBC Radio Manchester on Sounds and follow BBC Manchester on Facebook, X, and Instagram. Story ideas can also be submitted to northwest.newsonline@bbc.co.uk and via Whatsapp to 0808 100 2230. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content of external websites. Information regarding their approach to external linking is available.