One of the North East's most senior NHS figures has raised concerns about a lack of "urgency" in local government around the "really scary" issue of delayed discharges from hospitals.
Sir James Mackey - who is chief executive of the Northumbria Healthcare NHS Trust and also the NHS England figure in charge of managing the national elective recovery programme targeting spiralling waiting lists - made the comments at an event held by the Health Service Journal (HSJ) last week. After the event, he agreed to put his remarks on the record.
Sir James told the HSJ event that there was a need to "pull together" across the NHS and local government to tackle delayed discharges - which occur when "medically-fit" patients can not be sent home from hospital due to issues most often around the provision of home care or space in care homes. This results in hospital beds being blocked up and causes issues with "patient flow".
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The senior figure also spoke about how his trust was hoping to "disrupt" the social care system. In January plans, the Northumbria Healthcare NHS Trust revealed plan s to be the first in the country to expand and offer domiciliary care. In a presentation to the Northumberland County Council health and wellbeing overview and scrutiny committee, execs at the Trust also referred to plans to "develop an acquisition group to buy care homes". Sir James is also joining other NHS leaders in calling for infection control measures to be relaxed in hospitals.
At the HSJ event, he linked pressures from Covid-19 testing and distancing to the problem of "getting patients out the back door" - meaning delayed discharges. He said: "It feels a bit one-sided with all of the pressure coming down the NHS side of the house.... Local authorities, who have got other problems and so on, aren't quite seeing the terrible things we are seeing, or feeling the sense of urgency and emergency that there is.
"The first thing I would ask of [central] government colleagues would be to start off the conversation with local authority leaders, management teams, as well as political leaders about how urgent this is, and how we all need to pull together and do something because this is really scary."
He said hospital trusts were "really being hamstrung" by infection control rules which "don't seem proportionate any more" - adding: "We've now got a very different disease (much milder) and a largely vaccinated population. We need to test less and worry less about distancing etc and get back to local, risk-based decision-making as soon as possible and get beds open where safe to do so because we are now taking too much undifferentiated risk at the front door (and even before the front door with ambulance delays), and we cannot get patients out the back door."
As of March 27, there were 292 patients waiting to be discharged from one of the five NHS acute hospital trusts in our area who were otherwise medically-fit. 50 of those were on the wards at Northumbria's hospitals. Around England, there were more than 13,000 people in that situation.
In January, the North East figure was as high as 392 and hospital execs in South Tyneside and Sunderland, Gateshead and at the Northumbria said this had been exacerbated by staff absence - which has again been on the rise - and similar issues in the care sector. The NHS leaders said this had a "knock-on impact" on hospital activity more widely - because it affected how patients could be moved through the hospital system from the "front door", at A&E.
Delays in patients being able to get beds after being admitted to A&E then cause ambulance crews to struggle to hand-over patients to A&E in a timely fashion - this is an issue that the North East and North Cumbria Integrated Care System has been working on both with North East Ambulance Service and hospital trusts up and down the region.
The Northumbria Healthcare NHS Trust's plans for social care have so far - according to the presentation to Northumberland County Council - involved agreeing a structure for home care services, beginning phased recruitment and developing a "mobilisation plan". NHS execs also explained that "care home acquisitions [were] being identified and due diligence proforma in place".
Sir James said it the NHS moving into the sector would hopefully see benefits to staff and the wider system. He told the HSJ event: "The social care business care model is really stretched and the economics a challenge. Often staff are not paid well enough and it looks like a very transactional endeavour. My view would be that we [the NHS] will integrate domiciliary care into community health teams, use the economies of scale, pay them better, produce more [staff] and allow them to flow through the health and care system, being fully embraced as part of the health and care family."
However, he said care homes were a "completely different issue" - adding: "We will proceed with caution here as it is altogether more risky and costly... It's not something that we will do at scale - it would be about doing something to disrupt the system and try to set a new quality standard."
