Elderly patients are living at Northampton General Hospital for up to a year because the NHS cannot set up adequate home care, the Chronicle & Echo has learned.
The crisis is being caused by chronic delays in finding home care, with waits for a standard package - two carers four times a day - of “at least six weeks to eight weeks”.
One man arrived with a minor physical condition and stayed on a geriatric ward for 12 months even though, aside from his dementia, he was well.
Currently, the longest-staying person has been there a shocking nine months and counting. One hundred days, the Chron has learned, is not uncommon.
And the situation has been made worse recently when NHS Nene stopped paying for expensive private dementia beds at Angela Grace Care Centre in Cheyne Walk - which NGH staff say were working adequately - and tried to put home care (delivered by NHS Northamptonshire Healthcare staff) in place.
According to sources at the hospital, this made delays worse as the carers are rarely in place in a timely manner. The Angela Grace beds are still not being used because of high costs and the system is at an impasse. NGH says the issues have continued for so long it now has three wards of medically stable people who cannot leave.
Dr Sonia Swart, pictured on the opposite page, the hospital’s chief executive, said: “We have been having problems accessing the pathway efficiently.
“Patients with delirium and dementia do sometimes stay much too long in the acute hospital setting because of this.
“It is not the solution, but it is what is happening.”
Less temperate language is used by others at the hospital: “There is this assumption that they are ours to deal with. “ says one. “But hospitals don’t have the specialist skills because it’s not what we do. Effectively, these people are trapped here.”
Even official terminology isn’t much more positive. People aged over 75 who have been on a ward for more than a week are termed ‘stranded’. This applies to about half of that age group admitted to NGH.
Managers at the hospital confess to being at their wits’ end and NHS staff are coming up with increasingly outlandish ideas to break the loop. The fact that some of the most eccentric would still be an improvement on the current situation is a measure of the crisis.
One said: “ An NHS colleague had this idea of putting them on a cruise ship, and they were only half joking. They would probably enjoy it, it would be good for them, and it would be cheaper than keeping them in hospital.”
A further complicating factor is the fact that the assessment of dementia-type patients appears to be changing. People are increasingly being assessed (by NHS Northamptonshire Healthcare) with needing support for the similar - but, crucially, more temporary - delirium.
It is happening far more, recently, and it means there is a reason for keeping elderly patients in hospital much longer - as an NGH source put it, “in case it clears up”.
Dr Swart said: “What they are saying [in some cases] is that they have not got dementia, they have delirium and they might get better, so they can’t be put in a dementia place. “If they had dementia, they’d have much more support.”
All this is self-evidently bad for everyone. It is bad for other patients, who have waited in corridors on ambulance trolleys or suffered cancelled operations because of blocked beds .
It is also bad for the financial health of NGH because, although the hospital gets paid per dementia bed (which eventually increases during the inevitable lengthening of their stay),if doctors cannot admit everybody in need then they get fined for not hitting targets, cannot receive NHS surgery money and have to pay private hospitals to do operations. It is no coincidence that the hospital - like most - is unable to discharge a huge number of patients on time and is millions of pounds in debt (about £ 15 million).
Most of all, however, it is tragic for the patients themselves.
“They are at increased risk of infection,”says Mark Major of Northamptonshire Carers, who recognises the description of long-staying dementia patients.
“People can obviously be very disorientated and distressed sometimes and can be moved to different parts of the hospital. That becomes difficult for them and for their families.”
Helen Crawford, Alzheimer’s Society services manager for Northamptonshire said: “Hospital can be a frightening place for people with dementia, who often struggle to adapt to a new environment and routine.
“Despite the best efforts of dedicated NHS staff, there is a risk that people’s condition worsens whilst in hospital, which can have devastating consequences.”
At the moment no-one - not hospitals, not councils, not NHS trusts, not mental health trusts nor the Government - wants to pay for expensive care if it can be passed to another body. No -one wants the extra debt on their books and dementia is the prime pass the parcel example.
What can be done?
It seems simplistic, but more money needs to be pumped in from the top. Most people in the NHS now agree that efficiency schemes are no longer making a noticeable difference and austerity is having a crippling effect on acute trusts.
Several staff who talked to the Chron said they will soon be unable to take the strain of daily crises on dwindling funds.
Ideally, the money needs to go into a joint fund for both social care and the NHS (which are now so intertwined as to be essentially the same service) so people’s care from illness to recovery at home is paid for from the same pot.
For now, the situation is bleak,
Mrs Crawford says: “Cuts to social care budgets from central Government over the last few years have created a situation where many people with dementia are marooned in hospital because they can’t get the right support in the community.
“This spiral of decline needs to be addressed It hardly seems possible, but dementia, the most tragic condition yet discovered, is being made sadder still, by a health system flat on its back and barely able to move.
Until the Government admits there is a problem and ditches austerity for its own sake, our most vulnerable members of society will continue to live bewildered and confused on hospital wards. And without a voice.
In the words of the healthcare system whose prisoners they remain, they are marooned. Stranded. Trapped.