Bed-blocking crisis hits Queen Alexandra Hospital in Portsmouth

The accident and emergency department at Queen Alexandra Hospital in Cosham.'Picture: Ian Hargreaves  (14131-4)
The accident and emergency department at Queen Alexandra Hospital in Cosham.'Picture: Ian Hargreaves (14131-4)
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UP TO 150 beds at Queen Alexandra Hospital – the same as four entire wards – are being taken up by patients who shouldn’t be there.

That’s the claim from Portsmouth Hospitals NHS Trust’s chief executive Ursula Ward.

As a result of the bed blocking, it means patients coming in via QA’s emergency department are facing waits to get a bed and if there’s no space then they must go elsewhere.

And in the space of nine days, QA has twice had to ask for ambulances to take patients to other hospitals.

The first took place on October 28, where between 11am and 2pm, 11 patients were taken to Southampton General Hospital and one to St Richard’s Hospital, in Chichester.

Just over a week later the trust had to put out a second ‘divert alert’ on November 5.

This time nine patients were taken to Southampton.

In a letter from Ms Ward to a Portsmouth City Council health, overview and scrutiny panel, she said:

‘The key area for improvement for partners is the sustainable reduction in the number of patients that do not need to be in an acute bed for their continuing health or social care.

‘The number of patients in this group is frequently in excess of 130 at any given time, the equivalent of four wards.

‘It was agreed several months ago, as part of the system-wide accountability framework that there would be no more than 64 patients in the first instance in a hospital bed who did not need to be there.

‘The unscheduled care pathway performance remains challenging.

‘We continue to see a rise in attendances and increasing demand for services for the frail elderly population.

‘The hospital is running at occupancy rates frequently well in excess of 94 per cent, and that is even with additional escalation beds opened.

‘The key area within the trust for further improvement is delivery of the ward standards and discharge targets set by our clinical service centres.

‘This will require an improvement in the number of “simple” discharges achieved by clinical teams and good progress is being made.

Government guidelines state those coming into A&E should be seen, treated or discharged within four hours, 95 per cent of the time – a target PHT has failed to hit for around two years.

The trust said at some points up to 150 people are medically fit to leave, but cannot do so because other partners have not got care plans in place.

This includes Portsmouth City Council and Hampshire County Council’s adult social services, and community health providers Solent NHS Trust and Southern Health NHS Trust, which provide things like community nurses or medical equipment. PHT would not provide a breakdown of the reasons why patients are being held up.

Dr Jim Hogan, is head of the Portsmouth Clinical Commissioning Group, which pays for health services in the area.

He said: ‘There are still too many people being delayed both as they move within QA, and when they are ready to leave. When we talk about more than 100 patients being ready to leave hospital at any one time, that number appears high.

‘But it’s important to remember that some of these patients will actually be going home that day, as planned.

‘Again, others may only face short waits while staff ensure that significant amounts of support are in place so that they can be helped to go home.

‘Too many other patients, however, do face longer waits and that can be extremely difficult for them and their families. Stopping that happening can be a very complex task, but everyone in the local NHS is committed to tackling these issues.’

Portsmouth North MP Penny Mordaunt said MPs in the area are not happy with QA’s performance.

She said: ‘QA is not where it needs to be for MPs to be totally happy with the way the hospital is running, but improvements have been made.

‘It’s not a money issue but an organisational one as the trust will have some money each year to ease pressure.

‘Changes have been made such as the hospital’s pharmacy.

‘Portsmouth City Council is very good and bringing in care packages in a timely manner, but Hampshire County Council need to do more to get social care packages in place.’

Patient flow is key

SOLENT NHS Trust provides community and mental health services for Portsmouth.

Although it does not directly offer care packages, the trust said it supports Portsmouth City Council’s adult social care team.

A spokesman said: ‘As a trust, Solent runs seven-day services across community nursing, intermediate care teams, admission avoidance and supported discharge teams.

‘These teams are based within the hospital and inpatient units, all of which support the flow of patients.

‘Where we do not have responsibility to instigate care packages, we work very closely and proactively with adult social care to identify those patients requiring care packages and ensure they are implemented in a timely way so as not to delay discharge.

‘As a trust we are also able to follow these patients through services run by Portsmouth Hospitals NHS Trust, which helps support an earlier discharge from acute beds, allowing patients to be at home with support from the community services, where it is appropriate.’

County council deals with high patient numbers

HAMPSHIRE County Council provides care packages for patients.

Councillor Liz Fairhurst, who is in charge of adult social care, said: ‘We are aware of the significant demand on services at QA and we’re working closely with health and social care partners to support discharges as quickly and effectively as possible.

‘Speed of discharge depends on how a hospital as a whole operates, which means the availability of appropriate social care packages is only one of the elements that can delay a patient.

‘Our experience is the homecare agencies who operate in the Portsmouth area are very supportive, and this has resulted in quicker transfers and better outcomes.

‘As a large authority, Hampshire supports significant numbers of social care clients, so proportionately will always have more clients to support leaving hospital.

‘We continue to look for ways to speed up their discharge as quickly as possible, which includes maintaining hospital-based social care teams, with social workers linked to key wards who are able to bring in more resource.’

PORTSMOUTH City Council provides social care packages for patients living in the city

This could mean helping to find an appropriate nursing home for a person, or ensuring they have the correct support around them.

Rob Watt, director of adult services, said: ‘Our department works with colleagues in QA to facilitate safe discharge for people who are judged to be medically fit to leave hospital.

‘The health of people who were sufficiently, acutely unwell to be admitted to hospital – and who often have pre-existing conditions can fluctuate – means that the number of people on a “discharge list” is frequently changing.

‘Over the past five years, the council has had no delayed discharges attributable to social care and continues to be one of the authorities with low numbers of delays.

‘Adult social care is part of the team arranging care for people to be able to return home and, where necessary residential or nursing home care.

‘Hospital discharge is a health and social care system issue.’

Southern Health spearheads recovery scheme

SOUTHERN Health NHS Foundation trust provides community and mental health services to people living Hampshire, outside Portsmouth.

It says it has put in a number of programmes to help treat people outside hospital and prevent admissions.

Gethin Hughes, director of integrated services, said: ‘I’m extremely proud of our staff who work tirelessly to ensure people who use our services receive high quality, safe care.

‘This includes the Enhanced Support and Recovery at Home scheme in south east Hampshire, which helps people with complex health and social care needs retain their independence.

‘Since the scheme launched a year ago, the multi-disciplinary team has provided intensive support to 1,348 patients in their own homes instead of hospital.

‘Of those, just under half were inpatients who were able to be discharged from hospital earlier with appropriate support in place.’

‘We have introduced new senior clinical roles of experts in supporting frail patients, who provide specialist support and leadership to the hospital’s rehabilitation ward and other community teams.

‘These specialists are playing an important role to help patients return to home more quickly and more safely meaning more patients can access the

rehabilitation bed capacity in the community.

‘We continue to work closely with other health and care organisations and Hampshire County Council’s adult social care teams to improve patient journeys.’