INVESTIGATION: Bed blocking – why are psychiatric patients being delayed from leaving hospital?

Report first published in the Western Morning News, November 2017 and Devon Live:

The number of Devon psychiatric patients who were ready to be discharged from hospital but faced protracted delays, tripled in four years between 2012 and 2016, before significantly reducing this year, with the wait for residential or nursing home beds the greatest reason.

As the number of patients being cared for by the Devon Partnership NHS Trust waiting to vacate their hospital beds rose between 2012 and 2016, so too did the total number of days that beds were blocked from use by other patients needing a bed.

Demand for inpatient beds has never been higher and psychiatric patients can be delayed for a raft of reasons such as the wait for public funding, further non-acute NHS care, assessment completion or because of disputes and family choice.

It is well publicised that psychiatric hospital beds are in short supply across the county, including in Devon, where, in 2015/16, 111 patients were sent out of the county for a psychiatric inpatient bed, so any patient discharge delays are likely to exacerbate the problem.

According to figures obtained by the British Medical Association, published in June, the number of mental health patients travelling long distances for care in England has risen by 40 per cent in two years.

However Devon has bucked this trend; the number of patients being sent out of the area for a bed has reduced by around two thirds in recent years.

The rest of the UK has also experienced a rise in the number of psychiatric patients experiencing delays to being discharged from hospital.

Figures obtained via a series of Freedom of Information requests to 57 mental health care trusts across England revealed that almost half – 25 out of 56 that responded – experienced a rise in discharge delays between 2012 and 2016, with the wait for a bed in a residential or nursing home by far the greatest reason for the delays.

In Scotland, eight out of 12 health boards reported a rise in delays. And there were mixed outcomes across Wales and Northern Ireland.

Figures supplied by the Devon Partnership NHS Trust show that in 2012, 56 patients experienced delays to their discharge from hospital amounting to a total of 2,295 days. And for the first nine months of 2016, the number of patients experiencing delays had risen to 189, amounting to a total of 7,615 days.

However due to significant efforts made by the Trust to improve the situation, delays have reduced throughout 2017: the Trust’s target is that no more than 7.5 per cent of bed occupancy is attributable to delayed discharges: for 2016/17, the figure was 13.75 per cent, however for 2017 up until the end of September, the figure decreased substantially to 8.75 per cent.

In Devon, the wait for public funding and the wait for assessments to be completed were the next greatest reasons for delays, followed by waits for home based care packages and other non-acute NHS care.

The costs mental health care trusts between £350 and £750 a day for an inpatient bed.

In 2012 bed occupancy cost the Devon Partnership NHS Trust around £1.3m but in 2016 this rose to £3.3m including around £2m to accommodate those patients wait for a nursing/residential home placement.

A much-needed 10-bed psychiatric intensive care unit, and a mother and baby unit are scheduled to be built in 2019 in Devon.

A spokesman for Devon Partnership NHS Trust, said: “Like every other part of the country, we often struggle to discharge people from our inpatient wards, despite the fact that they are well enough to leave.

“There are a whole raft of reasons for this, but the most common one is that the necessary accommodation arrangements are not in place to ensure that the person will be safe and appropriately supported when they leave our care.

“This is particularly challenging for the older people that we support on our wards, many of whom can be frail and have very complex needs.

“We are working closely with all parts of the health and social care system to tackle the issue, including the councils in Devon and Torbay and we have made good progress over the last year or so.

“We have done everything possible to keep delays to a minimum and one of our most successful recent developments has been the introduction of Discharge Facilitators on most of our wards.

“These staff are focused solely on putting everything in place so that discharge can happen as soon as the person is ready to leave, and they have already made a huge difference.

“They have also freed-up valuable time for our nursing and other clinical staff, who can often spend large periods of their time trying to arrange discharges from the ward.”

A spokesman for Devon Country Council, added: “We work closely with Devon Partnership NHS Trust and monitor the issue of delays with them daily.

“Significant improvements have been made and the latest reporting suggests that this is continuing.

“We work with independent sector care providers to support discharge in a timely way.

“The most significant challenge is the increasing complexity of people’s needs and we are working across the system to make further improvements.”


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