IT is often said, and rightly so, that in spite of perennial concerns about waiting lists and nurse numbers, the NHS is second to none among state healthcare systems for its care of the seriously unwell.
Even these patients, however, are being affected by pressure on beds. An audit of critical care provision in high dependency units (HDUs), intensive care units (ICUs) and combined units in 2012 has revealed that one Scottish hospital, the Victoria Infirmary in Glasgow, discharged up to 8% of patients early from critical care into less acute wards.
Early discharge is defined as a transfer that is not in the best interests of a patient but necessary due to pressure on beds or staffing. Inverclyde Royal Hospital and Edinburgh Royal Infirmary also have high rates of early discharge.
Over at Forth Valley Health Board, meanwhile, what appears at first glance to be the opposite problem has emerged, with 45% of patients in the combined HDU/ICU at Forth Valley Royal Hospital having their discharge delayed.
In fact, this problem too is due to bed shortages, but in mainstream wards: patients are kept in critical care after the point at which they need to be there because there is simply not enough space on less acute wards.
Bed blocking on general wards, in other words, is causing bed blocking in critical care.
What all this means, as the Royal College of Nursing (Scotland) makes clear, is that many patients are having their recovery from serious illness and injury compromised.
For the past month, The Herald has been calling for a review of bed capacity as part of our NHS: Time for Action campaign. With an ageing population putting unprecedented pressures on the system, it is clear that such a review is needed to ensure there are the right beds with the right staff in the right place at the right time to cope with patient demand. Not having sufficient capacity in one part of a hospital has a ripple effect on other departments, as this report illustrates all too clearly: it could mean patients being held overnight on trolleys in A&E; it could mean patients being repeatedly moved between wards because the appropriate one is full; or it could mean that patients in critical care settings are discharged too early or too late.
A beds review is essential, but there also needs to be a proper investigation into community care provision. One cause of bed blocking is the holding of a patient in hospital while a care home place is found for them, or home care arranged. The process is often inefficient; what is more, sometimes such patients did not really need to be admitted to hospital in the first place but were brought in because of a lack of alternatives. Such issues must be addressed if the overall problem of bed shortages is to be dealt with. It is clear that early and delayed discharges from critical care are symptomatic of a much wider problem of hospital bed capacity that will probably become worse unless it is addressed now.
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereComments are closed on this article