High hospital bed occupancy rates must be addressed as a matter of urgency before winter pressures kick in, according to trust regulator NHS Improvement.
The warning follows the publication of data on NHS providers’ performance from April to June this year, which shows “extremely high” levels of bed occupancy.
“The rising costs hospitals are being asked to absorb will eat up all the benefits”
During this period, the average general and acute bed occupancy level was 89.1%, with rates routinely climbing above this level.
The quarterly report, published on 1 September, said the “position is still extremely challenging”, with the number of elective patients waiting for treatment exceeding 3.6million for the first time since the waiting time target was introduced in August 2007.
High levels of bed occupancy “continue to affect the sector’s ability to admit patients who require planned care, and also impacts more generally on hospitals’ ability to care for patients in a timely, effective manner”, said the report.
The increase in occupancy is in part due to increased pressure on accident and emergency departments, with a 3.81% increase in emergency admissions via A&E, compared to the same period last year.
“The challenge lies not just in hospitals – we have shortages of community nurses”
NHS Improvement also highlighted a “lack of progress in reducing delayed discharges”.
The latest data shows some hospitals are still having problems when it comes to discharging medically fit people. However, the proportion of delayed discharges due to issues with social care has gone up, despite investment in the sector.
In June, 55% of delayed transfers of care were caused by the NHS, while 38% were caused by social care – these are the lowest rates for the NHS and highest rates for social care since records began in 2010, according to NHS Improvement.
“Since the government announced £1bn investment for adult social care in March 2017, the level of delayed transfers of care has increased,” said the report.
“To address this, it will be essential for local health and care systems to work together to ensure sufficient beds are available so that patients can continue to rely on safe, high quality care over the busy winter period,” it added.
“Our hospitals are very busy already, and it’s still relatively early in the year”
NHS Improvement chief executive Jim Mackey, who is stepping down this autumn, said the NHS needed to “focus hard on the bed situation”.
“Our hospitals are very busy already, and it’s still relatively early in the year. Last winter we ended up opening over 4,500 beds at the busiest times, mostly in an unplanned and unproductive manner,” he said.
He maintained winter planning was “progressing well” under the leadership of national urgent and emergency care director Pauline Philip.
“But more needs to be done urgently to address the occupancy situation, in sufficient time for a more planned approach to this coming winter, and to maintain the standards we are all aiming for,” he added.
When it comes to finances, NHS Improvement said the data showed NHS providers’ performance was broadly on target although the sector is forecasting a deficit of £523m at the end of 2017-18 – £27m worse than planned.
The report states the majority of providers “have once again set stretching plans to achieve value for money”.
So far, 206 out of 233 – 88% – have signed up to a financial “control total” and 166 or 71% are on or exceeding targets.
Meanwhile, the data shows providers’ overall spending on agency shifts in the first quarter of this financial year was £169m, which is 22% lower than the same period last year.
John Appleby, chief economist for the Nuffield Trust, said that, despite the fact that agency spending was improving and health service staff had worked hard to deliver savings, trusts still faced “an uphill struggle” to balance the books.
“Unfortunately, the rising costs hospitals are being asked to absorb will eat up all the benefits of improved efficiencies,” he said. “This will leave them yet again with significant underlying deficit at the end of this financial year.”
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Niall Dickson, chief executive of the NHS Confederation, which represents health organisations in England, Wales and Northern Ireland, said: “These latest figures prove our members are delivering high quality services against all the odds at a time of unprecedented demand and financial pressure.
“However, the fact that A&E attendances and admissions continue to rise demonstrates the pressure the provider sector is under,” he said.
He added: “The challenge lies not just in hospitals – we have shortages of community nurses, GPs, social care services and nursing home places, all of which are vital in taking pressure off the hospitals.
“Last year the NHS managed incredibly well but we cannot continue just to rely on a hope that viruses will not wreak havoc, that the weather will be clement and that staff commitment will get us through,” he said.