Healthcare delivery
of skilled and experienced people are radiographers, ultrasound technicians and MRI clinicians, as well as estates workers, IT and administrative staff, call handlers, allied health professionals and healthcare support workers. In nursing, the shortages are particularly bad in bands 2-4 and 6-7, specifically in mental health, learning disability and district nursing. It has also been suggested that both senior and mid-level managers are short, which may have contributed to the sluggish growth in activity.7
Lack of bed capacity The NHS has fewer acute hospital beds per head of population than other OECD countries and runs at very high occupancy levels. The urgent and emergency recovery plan aims to increase bed capacity, as well as set up virtual wards where patients are monitored at home.8
The bed
shortage is compounded by an increase in patient acuity and a longer length of stay. A sustained increase in acuity is pressurising services, bed capacity and, in some cases, increasing theatre time. As some patients are sicker, presenting with later stage disease or living longer with multiple long-term conditions, they require more resources for longer to deliver quality care.9
In addition, we have heard recently that a
lack of social care capacity is having a knock-on effect on hospital care, including the timely discharge of medically fit people to home with support or to social care. Hold ups occur because of lack of beds in social care, as well as the need to install specialist equipment in people’s homes, or a disagreement between a patient, their family and medical staff about the level of support which may be needed in future. It is also cited that there are hold-ups in sorting transport, medicines and paperwork in the hospital. An average of 1,791 patients in June, who had been in hospital for at least two weeks, were unable to be discharged due to a lack of a bed in a residential or nursing home. In addition, more than 2,000 patients a day were waiting for resources to assess and begin care at home.10 The overall numbers of patients in hospital
beds, waiting for discharge when medically fit was an average of 12,334 beds in England in June.
Financial challenges Trusts are being asked, as they are every year, to make efficiency savings. The rate varies across different organisations, but some are reporting that they need to make 5% savings. Many have
Some of the bed capacity could be released if resources were put into social care and community support to patient care at home. It would certainly not solve the issues set out, but it would start to unstick the apparently insoluble problems.
made a lot of short-term cost savings over past years and complain that there is little further fat to cut from the bone – this is adding an additional challenge to the already difficult situation. As previously mentioned, funding the costs of agency staff to cover strikes has been an expensive business and may be continuing with junior doctors having announced further strikes into August. There are standards for minimum staffing levels to ensure safety is not compromised, so Trusts are in a difficult position. NHS England has also introduced spending caps on agency spends to bring down agency spend to below 3.7% of the pay bill. This spending cap may make Trusts reduce some areas of care, while maintaining others, in order to balance the books. Inflation is also having a considerable impact in healthcare, as it is in all walks of life, but is particularly affecting energy, utilities and medicine costs. As Trusts continue to be exposed to higher costs, they remain concerned that national tariff uplifts will not cover the impact of inflationary cost increases. Recovering the backlog remains a national and political priority but gives Trusts another challenge. In the past they have managed spikes in demand for urgent and emergency care by reducing elective activity, but this is no longer a viable option. However, it does give a further challenge with strikes reducing elective activity and, the payment system being based on activity, income may well be reduced during the year. Any further rise in emergency care will affect the financial situation even more.11 Trusts did not feel that the NHS has the
capacity to continue to make efficiency improvements because the resource available to
September 2023 I
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