the health strategist
institute for continuous health transformation
and digital health
Joaquim Cardoso MSc
Senior Advisor for Continuous Health Transformation
and Digital Health
January 6, 2023
Executive Summary
What is the problem?
- Hospitals in the UK are facing overcrowding and are struggling to keep up with demand for care during the winter season.
- Approximately 13,000 beds in hospitals in England are occupied by “delayed discharge” patients.
What are the causes?
- One reason for the overcrowding is the high number of “delayed discharge” patients, …
- or patients who are fit to leave the hospital but are unable to do so due to a lack of available care options.
What is the solution?
- The care hotels are staffed by a combination of private care agencies and NHS staff, and provide support to patients who are not in need of hospital care but are not yet ready to return home.
Who is doing it?
- NHS trusts providing acute care in Devon, Cornwall, and Bristol are transferring patients to the care hotels.
- The hotels are being staffed by a combination of Abicare, a Care Quality Commission-registered provider of domiciliary or at-home care services, and NHS staff from rehabilitation and primary care services.
What are the benefits?
- The use of care hotels allows hospitals to free up beds for patients in need of more intensive care, and helps to improve the flow of patients through the hospital system.
- It also provides a welcoming environment for patients who are not in need of hospital care but require further support before returning home.
Approximately 13,000 beds in hospitals in England are occupied by “delayed discharge” patients.
After discharge, patients are looked after in the hotels by staff from a private care agency employed by the NHS until a package of care can be arranged for their return home or to a care home.
DEEP DIVE
The Guardian
Denis Campbell , Health policy editor
Thu 5 Jan 2023
Hospitals in several parts of England are discharging patients into “care hotels” in an effort to free up desperately needed beds to help them cope with the NHS winter crisis.
NHS trusts providing acute care in Devon, Cornwall and Bristol, along with surrounding areas, have begun moving patients who are medically fit to leave into hotels.
The move is a revival of a practice used by the NHS in England during the pandemic, when hospitals sought to clear as many beds as possible for use by patients with Covid-19. It is based on a model of care widely used in Nordic countries to ease hospital overcrowding.
NHS Devon has booked 40 rooms at the Leonardo hotel in Plymouth, 10 of which are being used by the NHS Cornwall and Isles of Scilly integrated care board to discharge patients. The board is looking into arranging a similar setup itself, the i reported.
Bristol, North Somerset and South Gloucestershire integrated care board has been using rooms at an unnamed hotel in the city since November to accommodate up to 30 patients.
Some hospitals have used care hotels on and off since Covid hit in early 2020 to ease overcrowding and speed the release of beds occupied by people with no medical reason to still be an inpatient.
They are mainly people with low medical needs who doctors have decided are taking up a hospital bed unnecessarily and can be safely looked after elsewhere.
After discharge, patients are looked after in the hotel by staff from a private care agency employed by the NHS. They stay in the hotel — sometimes for weeks — until the local council and NHS have arranged a care package to enable them to return to their home or care home.
A spokesperson for the Bristol, North Somerset and South Gloucestershire integrated care board said: “Local health and care services are under significant pressure and this temporary care facility delivered at a local hotel will help us to improve the flow of patients through our hospitals by ensuring more people can be discharged as soon as they are medically fit to leave hospital.
“It will also improve the flow of patients through our hospitals while helping to address ambulance handover delays.
“The service will operate until the end of March 2023 and will provide comprehensive care, in a welcoming environment, for people who don’t need to be in hospital, but require further support before they return home.”
Discharged patients are expected to spend an average of three weeks at the hotel. They are being looked after by a combination of Abicare, a Care Quality Commission-registered provider of at-home personal care services, and NHS rehabilitation and primary care staff.
Caroline Abrahams, the charity director at Age UK, criticised the care hotels and told the i that hospitals resort to using them to help them negotiate the surge in demand for urgent and emergency care. She said it underlined “just how severe the crisis in social care has become” and that “hotels are not an appropriate place to provide high-quality care for older people in need of support to recuperate after a spell in hospital”.
About 13,000 beds in hospitals in England — approximately one in eight of the total stock — are occupied by “delayed discharge” patients who end up stuck there, sometimes for months.
Rishi Sunak, in his first major speech as prime minister on Wednesday, echoed concerns expressed by hospital bosses and senior doctors that having so many beds occupied by such patients was a key reason ambulances could not unload patients to A&E staff quickly and emergency departments were being overwhelmed.
NHS England promised last autumn to create 7,000 extra beds by March to help hospitals deal with winter pressures. They were due to come from discharging medically fit patients and expanding “virtual wards”, in which patients receive care at home.
The Royal Stoke hospital has “reluctantly” agreed to start looking after patients in the corridor of its A&E unit again, a year after banning the practice because it posed “significant” risks to patients’ safety, the Health Service Journal reported.
Hospital bosses have agreed that up to 15 patients can be cared for on trolleys in the corridor of its A&E, 24 hours a day if needed, despite them having no call bells or piped oxygen, in an attempt to cut the number of ambulances forced to queue up outside.
Originally published at https://www.theguardian.com on January 5, 2023.
Names mentioned
- Rishi Sunak, the Prime Minister of the UK
- Caroline Abrahams, the charity director at Age UK
