SPECIAL REPORT: Three wards worth of fit patients cannot leave Northampton General Hospital

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The chief executive of Northampton General Hospital has issued a call for urgent action on bed blocking because 110 fit patients are unable to leave its wards.

Although she stresses that delayed discharges are as much NGH’s responsibility as the wider NHS and the county council, Dr Sonia Swart said all parts of the health system were not acting with as much urgency as the county’s hospitals.

Dr Sonia Swart

Dr Sonia Swart

She said: “Collectively, we are not meeting the needs of the patients we serve.

“We had more than a hundred delayed discharge patients last week – three-and-a-half wards worth – and, more importantly, the numbers have not been going down.

“Things were agreed last summer to bring them down and we have just had eight weeks of the worst consistent pressure we’ve ever had.

“We were genuinely worried that if this continued it would pose a risk to patients. This is a call to action.”

Collectively, we are not meeting the needs of the patients we serve.

Dr Sonia Swart

Dr Swart said that with wards frequently operating a virtual one-in-one out policy, staff wanted to leave and patients were being left without a bed.

She said: “You wouldn’t want a patient with a heart attack, a stroke or major bleed to come to a hospital that is so full they can’t get a bed straight away in the right department​ and that’s what’s happening.

“It’s not what we would want for our families and its not what I’d want for our patients in this hospital and it is having a huge impact on our staff. Staff who are working when we are so pressured are genuinely worried about patients. They haven’t got the time they’d like to explain things to people.

“That makes me feel like this can’t continue.”

Last week, there were 165 fit patients at NGH and KGH who could not be discharged.

Often it’s because elderly people with complex illnesses need home care assessments by social services, which can take days and weeks.

As a result, doctors cannot be sure the patient would be safe at home and so keep them in hospital, stopping new patients being admitted.

Effects of this include long queues in A&E, ambulance response delays, cancelled operations and patients being moved wards in the middle of the night. The nub of the issue is that the pressure is all on hospitals to get patients admitted quickly to hit targets, but there is no similar imperative to get them out quickly when they are better.

One of the major changes, since March, has been to put NHS Northamptonshire Healthcare in sole charge of complex discharges, although it is too early for any positive effects to emerge.

Given the progress,​ though,​ why did NGH and KGH decide to release a letter criticising the county’s discharge system?

Dr Swart said: “I’ve raised this on about 30 occasions in meetings in the last three years. You might see it as unhelpful but it is formally stating to our partners that we have an unacceptable level of risk, which we need to resolve.

“If I hadn’t raised this publicly I might as well ​h​ave sent a letter. What’s the point of writing a letter, they’d put it in a drawer?

“We had 8 weeks of the worst consistent pressure we’ve ever had. We were genuinely worried that if this continued it would pose a risk to patients. This is why we did this.

“If you look at the reports on Morecambe Bay, people were covering things up. We think the public have a right to know what is happening.”

Although actions have been put in place before and since the letter, NGH board members’ worry for staff and patients persists.

Dr Swart said: “It will be a worry until we reduce the pressure in the system so that everyone can go straight to the right bed at any time.

“We are managing our risks as carefully as we can but we were drawing attention to the fact this can’t go on.”

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COUNTY HALL ‘CONTINUING TO MEET WITH NGH’ AND TAKING ACTIONS

Northamptonshire County Council said it was putting together a range of measures to help get people who no longer needed hospital treatment to get off wards quickly.

County Hall is paying for a range of services to help to get well

people out of hospital, including block-buying beds in care homes while they wait for a home care

package, a spokesman said. Social services is also increasing resources for the voluntary sector so that they can assist people when they go home, as well as “working to build up domiciliary care” to help avoid unnecessary admissions.

A spokeswoman for Northamptonshire County Council said: “We continue to work closely with our partners in the NHS with regular meetings to discuss the current issue.

“We are also exploring ways people can maintain their independence by remaining in their own home for as long as possible, with care and support.”

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HOSPITAL CHIEFS SAY THE RISK TO PATIENTS COULD RISE

RISKS to patient safety “will become more significant” unless the NHS and county council get well people out of hospital more quickly, according to county hospital bosses.

Their strongly-worded letter to the county’s four other major NHS trusts, plus Northamptonshire County Council, says Northampton and Kettering hospital chiefs are worried that red tape is preventing patients being discharged when they are ready to leave hospital.

In what Dr Sonia Swart, chief executive of NGH, has since described as a “call to arms” she and Kettering Hospital chief executive David Sissling wrote: “Despite our repeated requests we still do not always detect an appropriate and consistent level of urgency in responding to the delayed discharges.

“All too often matters of process or definition appear to get in the way of required actions.”

The letter was dated last week and Dr Swart has since said the hospitals were not blaming any one organisation.

But Dr Swart and Mr Sissling also said they were concerned by the “very substantial impact on our staff” who are “working with great dedication, but are subject to sustained pressure”.

The letter goes on to talk about concerns about patient safety.

It says: “In responding to the pressures we face, we will continue to prioritise patient safety.

“We are actually taking all reasonable steps to mitigate clinical risks regardless of any financial impact. We must, however, convey our view that the risks to quality and, potentially, safety will become ever more significant unless appropriate responsive action is taken.”