Bed blocking fuelling rise in ambulance response times, says Cornwall hospital boss
The Chief Executive of the RCHT has warned up to 200 patients are ready to leave
Last updated 8th Jul 2022
The boss of Cornwall’s main hospital has said that the issues with beds being blocked by patients waiting to be discharged has led to an “extraordinary” situation where ambulance response and waiting times are increasing and the hospital's stroke service is deteriorating.
Royal Cornwall Hospital has been reporting for months that hundreds of beds are being blocked by patients who are medically fit to be discharged but have no care services ready for them to go to.
The issue has had an impact throughout the hospital including pressures in getting patients into the emergency department which has led to ambulances queuing up outside the Truro hospital.
Steve Williamson, Chief Executive of Royal Cornwall Hospitals NHS Trust (RCHT), told the trust’s board that work being done to relieve the situation is not working and urged the board to write to the Integrated Care Board to ensure that more is done to help.
In his report to the board he said that there were "up to 200 people – the equivalent of seven full wards across acute and community hospitals in Cornwall – who have finished their hospital treatment and are ready for discharge from hospital and should either be in their own home with care support or in other appropriate settings, to continue their reablement and to maintain and maximise their ongoing independence".
He said that the number of people with the lowest level of need had doubled since March. He added: "Without these delays there would be sufficient hospital bed capacity within Cornwall to accommodate emergency admissions, as well as those waiting for planned procedures".
Mr Williamson said: "The pressures that Royal Cornwall Hospital faces with the number of patients waiting for discharge to care services is increasing. We are under increasing pressure and challenges.
"We are being used as a proxy social care facility or for domiciliary care. That is impacting directly on emergency care for patients to be admitted in a timely way and has a direct impact on ambulances waiting to get patients into hospital".
The Chief Executive said that the problem with patients who are medically fit to leave hospital occupying beds was also affecting other services in the hospital and across the health system in Cornwall. He added that in June the average response time for an emergency ambulance in Cornwall was "just over two hours".
'Up to 200 patients ready to leave and waiting for onward care'
He said: "That is an exceptional challenge and needs to be addressed. If we look at stroke services, our services were named by the National Audit Office as some of the best in the country, that has deteriorated as a result of the challenges that I have outlined.
"It is imperative and essential that all partners of the health and care system in Cornwall and the Isles of Scilly do everything that they can to address these challenges".
Mr Williamson was asked how the situation compared now to before the Covid-19 pandemic and he said that delayed discharges had risen by 80 per cent compared to the figures in 2019.
He said: "It is an 80% increase in the scale of the challenge that we paced pre-pandemic. That position has continued to deteriorate over the last few months. We are facing an increasing challenge around this. It is an extraordinary challenge in delivering the expectations that we have for our level of care in the trust.
"Not only do we have more beds occupied by patients who are ready for discharge but they are staying longer. More beds are occupied by patients who are no longer needing medical treatment, they are waiting discharge. We need to bring together health and social care leaders to do everything they can to help the entire system, not just Royal Cornwall Hospital".
Mr Williamson said that whilst health and social care partners, including Cornwall Council, had expressed commitment to help ease the problems the action which had been taken had not had any impact and that the pressure is increasing.
“What I have seen from partners across the system is a desire and willingness to progress this work, but that has not translated into reducing the number of patients occupying our hospital beds or any beds across Cornwall.
“At this stage I could not have confidence in the evidence that all these actions are delivering the improvement that we require as they are not reducing the pressure.”
Non-executive board member Sarah Newton said she was concerned about the impact on stroke services: “It must be heartbreaking for staff in stroke services and patients to have one of the best stroke services in the UK be now deteriorating as you can’t get people into hospital in a timely way to treat them. People are not getting the care that they need.”
Dr Mairi Mclean, chair of the RCHT board, said that the board may need to write to the Integrated Care Board to reflect the concerns which had been raised by Mr Williamson and “hope” that more will be done to help ease pressure on the hospital.
The hospital chief executive said that it would be “helpful” and urged the board to take that action “in the next couple of days” to ensure it would be considered at the next ICB meeting next week. The board agreed to write a letter to the ICB to impress the concerns of Mr Williamson.