The NHS in Scotland is under enormous pressure. Three health boards north of the border have halted non-urgent elective care as the crisis worsens. Urgent cancer treatment and care is being prioritized as patient demand continues to rise beyond unmanageable levels. The last time we saw this happen was during the pandemic. What is going so wrong?
One of the main problems in Scottish hospitals is block the bed: the wards are full of patients who cannot be discharged. This means there is no room for those who go to the ER and require overnight admission.
The shocking part, though, is that many of those patients stuck in hospitals don’t need to be there. On average, there are 1,950 late discharges from Scottish hospitals every day. The number of people who are medically fit for discharge (which is a little different than being “medically fit”) is increasing. So is the number of patients waiting more than 12 hours in emergency departments.
These patients, fit for discharge but confined to hospital beds, remain on wards not because there are problems with hospital transport or finding staff to help move them, but because social care in Scotland is coming to a halt. claire Burden, chief executive of NHS Ayrshire & Arran, one of the health boards suspending elective treatment, told staff: ‘These pressures are also faced in our social care services in East, North and South Ayrshire. In particular, home care services in the three medical and social care associations are particularly affected by increased demand, as well as workforce challenges.”
And it’s true: Scotland’s hospitals are at 95 per cent occupancy levels as of last Wednesday. Several young doctors in Scotland told me that their wards were filling up and that many patients, who no longer needed hospital treatment, could not leave.
“Half my ward is medically fit, and the patients just need a care package,” one told me. Another doctor, who worked in an operating room, described his current situation after being told about the pause in elective operations:
“They have stopped all the elective theater to free up beds,” they said. “People now come to the hospital extremely poorly, they are put on ‘medicine’ but given a bed in operating rooms.”
Just a few months ago, Jillian Evans, head of health intelligence at NHS Grampian, warned of the dire state of the care sector:
“We know there is such an increase, the highest levels we’ve seen in years, of patients who are clinically unfit to be discharged due to shortages of social care staff in the community or in nursing homes.”
His words have been fulfilled. The governments of Scotland and England are trying to buy nursing home beds so that this congestion can start to ease. Health Secretary Steve Barclay said this week that up to £250 million would be spent to speed up the hospital discharge process. In Scotland, Nicola Sturgeon announced that “immediate additional funding” will be given to boards of health so they can buy nursing home beds to help speed up the discharge of patients from hospital.
None of these offer a simple solution. I spoke to the manager of a nursing home in Scotland who told me that while the local council contacted his place of work and offered them beds considerably higher than the asking price (approximately £1100 against the normal rate of £832), it just doesn’t. It doesn’t have any extra capacity. The house is full and there is already a waiting list.
For those nursing homes with spare beds, there are also questions about whether staff will have a say in which patients they accept from the hospital. Certain patients may be more difficult to manage than others, depending on their condition, and local care homes may not be adequately staffed or equipped. gentle of staff (nurses, rather than caregivers), to handle the influx. A carer told me how the pressure on the sector is spreading from the health service. Because councils bought beds for patients coming from the hospital, it was much more difficult for patients in the community to get a bed at a local nursing home.
The care sector is already under pressure: carers are leaving the industry due to dissatisfaction with their working conditions and pay. Another caregiver told me how there is a growing problem with home care, which allows people to stay in their own homes. Staff often have to travel a long way to reach patients’ homes, and many are finding that the high cost of fuel is becoming unaffordable, particularly when expenses often do not cover actual fuel prices.
England has seen its social care workforce decline significantly; The country is projected to require almost half a million more staff by the middle of the next decade, but the industry lost 50,000 workers last year, leaving about 165,000 vacancies. He panorama for Scotland’s care workforce it’s a little less bleak: the workforce has declined by 0.6 per cent since 2020, with a stability rate of 75.5 per cent (meaning around three-quarters of parts of the workforce remained in the same position since last year). But there is a staffing crisis, as Donald Macaskill, chief executive of Scottish Care, told the BBC. November. He warned that 40 percent of the country’s 800 private nursing homes could close due to rising energy costs and staff shortages.
And while nursing homes struggle to make space for patients who need to leave hospital, the NHS struggles to find beds for those new patients who need to be admitted each day. An email was sent to staff at Claire Burden of NHS Ayrshire & Arran on Tuesday announcing that elective procedures and routine appointments would be paused. “We will be pausing routine elective inpatient surgery for a period of three weeks beginning Monday, January 9, 2023,” the email said. ‘We continue to focus on decongesting our acute and community hospitals, which will help us relieve pressure on our Emergency Departments and Combined Assessment Units… We have opened up all additional beds where possible, and are looking at alternative avenues for those patients who do not require their care to be provided in an acute hospital setting.’
The board of health extended this change to general practices in the area, with Burden writing that “due to overwhelming demand in general practice, we are asking general practitioner practices to switch to seeing only urgent care and acute care patients.” emergency”.
Both NHS Borders and NHS Greater Glasgow & Clyde (the latter Scotland’s largest board of health) have told their staff something similar, and have also temporarily paused elective procedures to prioritize urgent cases. This means that any patient expecting to attend a routine operation during this three-week period will have their appointment rescheduled. Unaffected patients include children, those who require urgent treatment, or patients who can be operated on as a ‘day case’, meaning they will not need a hospital bed. NHS Greater Glasgow & Clyde issued an apology to patients affected by this alarming move, promising that it will “do everything possible to offer them an alternative date at the earliest opportunity.”
The blockade of beds in Scottish hospitals is out of control. Patients who need treatment cannot get the help they need. But the ‘solution’, of buying nursing home beds in an attempt to empty hospitals, affects those patients in the community who also need access to care. It feels like trying to fix an open wound with a cheap plaster. Until staffing issues in both the NHS and the care sector can be sorted out, and until more physical space can be made available with adequate staffing levels (rather than re-using existing beds), this capacity crisis it won’t go anywhere.