Up to 18,000 “super stranded” patients remain in hospital after being medically optimised for more than 21 days, NHS chief executive Simon Stevens has stated.
This is equivalent to the bed base of 36 acute hospitals being taken by patients who are not in need of acute care, but who are delayed for other reasons (choice delays, assessment delays, community services provision).
The figures were discussed during a recent appearance by Mr Stevens before the Commons’ Health and Social Care Committee.
Winter (2017/8) saw a focus on delayed hospital discharges with some qualified success. It is estimated the drive released 1,700 beds, although they were quickly filled by patients with flu and norovirus.
Discussions around planning for the next winter (2018/9) have again featured the issue of delayed discharges, with this time with an emphasis upon the “super stranded” patients, delayed by 21 days or more. Although most delays to discharge are typically less than 21 days, the ‘super stranded’ take up a disproportionately large proportion of hospital bed days due to their long length of stay.
It is understood that new plans might include incentives for social care providers to prioritise care packages for patients in the “super stranded” category.
Optimising the use of NHS England’s 128,000 bed base will be critical next winter as it is uncertain whether there is likely to be any significant cash injection or commitment to increasing the acute bed base.
What is the shortfall in capacity? NHS national leaders have recently suggested the service is at least 4,000 beds short of what is needed to meet A&E and bed occupancy targets. NHS Providers have stated the shortfall is much higher: 15,000 beds short (or 12 per cent of overall bed base).
But it was notable that after Mr Stevens’s committee appearance, subsequent NHSE briefings were heavily focused on optimising the existing bed capacity and particularly on super stranded patients. A spokesman told the Health Service Journal:
“As Simon Stevens told the [committee] last week, around 18,000 people currently in hospital have been ‘stuck’ there for more than 21 days. That’s the equivalent of 36 acute hospitals being ‘out of action’ because of delays getting patients out of beds.
“Building on recent success in reducing DTOC, the operational focus or the year ahead will now turn to reducing super stranded patient numbers in partnership with local community health providers and social care services.”
CHS Healthcare has worked in hospital discharge for 20 years and is currently commissioned to provide in-house hospital discharge services (including discharge to assess) in more than 30 hospitals across the country. We are commissioned by NHS Improvement to provide focused support in areas under particular pressure.
Dr Richard Newland, chief executive of CHS Healthcare “We recognise this concept of the ‘super stranded patient’; we regularly see these sorts of delays in hospitals where we work. When there are complex care needs, there will be multiple agencies involved and together with family choice, a myriad of actions required to achieve discharge.
“It is therefore very easy for delays to occur and when they do, two things are essential: there must be ‘ownership’ of the discharge; person centred care co-ordination of all the actions involved and focus on all causes of delay. Otherwise, it can become a case of ‘waiting for someone else to do something’. Equally, strong tracking and data is vital for visibility of all delayed patients and robust information to show the exact causes of the delays.”