Delayed discharge numbers ‘stubbornly high’ at NHSO

NHS and social care managers in Orkney continue to struggle to cope with the rising demand to support frail elderly individuals.

Targets to cut down on delayed discharges from hospitals and providing care-at-home packages are routinely missed – as is the case in many other parts of the country.

Frustration at the lack of progress surfaced at NHS Orkney’s latest board meeting on February 26.

There was also a plea not to centre the issue on bed-blocking but to also consider the impact it is having on families and unpaid carers.

The latest data showed that the board is consistently 50 per cent or less compliant with the target to have patients at The Balfour discharged within 14 days of being assessed for a care package. In January the figure stood at 37.5 per cent.

Of the 16 in that category in mid-January, five were waiting for a place in a care home.

The number of hospital bed days associated with delayed discharges over the month was 409 against the target of 56.

The board also heard that 50 individuals in Orkney are currently on the waiting list for a care-at-home package. 

Non executive member Rona Gold said she understands the pressures faced by the service tasked with arranging a transfer from hospital to a care home or with a care package in their own home.

But she asked: “What timescale can we expect to see a move towards reaching our target on this, recognising that where we are now is quite far away from that?”

Stephen Brown, chief officer of Orkney Health and Care, said the causes of delayed transfers of care are varied.

In terms of bed-blocking, there can be a shortage of care home places while the need to secure a guardianship order over an individual with incapacity will cause a hold-up.

Mr Brown said: “The number of delayed transfers are stubbornly high, sitting consistently at between 17 and 19.”

He said staffing shortages can meanwhile slow down the process of putting a care-at-home package in place though he said 52 people have secured this support over the past four months.

Mr Brown said the worry is that those on the waiting list could end up presenting as an emergency at the casualty unit.

“There are real pressures,” he said. “There’s no obvious answer to when this will start to shift.”

GP representative Kirsty Cole was concerned the issue tends to be dominated by the effect delayed discharges have on hospital beds.

She believed the impact on unpaid carers and families of individuals waiting for care-at-home packages needs to be highlighted.

Mr Brown said this is a fair point.

He said: “We recognise the impact on family and carers and the risks that people are living with when they have clearly been assessed for care packages and we’re not able to facilitate that as quickly as would like.”

On a positive note, he said extra care staff are due to start over the next few weeks, which should start to see numbers on the list come down.

A number of initiatives are also under way including ongoing work to reduce the number of falls vulnerable and elderly people experience in the community.

Acting board chief executive John Goodyear said action is needed in the hospital and the community if the issue is to be properly tackled.

“It needs both sides to play their part. We must do something about this as the current level of pressure, and therefore risk, isn’t tenable.

“We have seen a step change increase since this time last year and we must see a step change decrease.”