Delayed discharges from Western Isles Hospital branded 'chronic problem' as cost soars to £1.8m

The delayed discharge of patients from Western Isles Hospital has been described by the chief executive of NHS Western Isles (NHSWI) as a “chronic problem with acute periods” as the cost to the board of the problem in the last year was confirmed as being £1.8m.

Figures for the first part of this financial year show a risk that that figure could also be exceeded, with costs for the first two months of 24/25 being £368k.

Speaking at last week’s meeting of the NHS Western Isles Board, Debbie Bozkurt, NHSWI’s director of finance and procurement said the “very high level of delayed discharge locally” was the “biggest issue” the board was facing financially as well as clinically, and confirmed that it had resulted in the opening of “unbudgeted beds” in the hospital to cope with demand, and the costs associated with that requirement.

Last year there were 15 instances of delayed discharges locally and Nick Fayers, chief officer of Western Isles Integration Joint Board, told the meeting that the percentage of patients who ‘arrive at delayed discharge’ is currently at circa 5% of all those cared for, and that more than 40% of admissions to hospital locally were over 75 years old.

The board heard that In July, as part of a bid by the Scottish Government to address the problem nationwide, a new target for delayed discharges nationally was set at 34.6 delays per 100,000 population (for those 17 years and over).

This produced a target for the Western Isles for the current year of a maximum of seven delayed discharges – a year-on-year reduction of 53%, and the fifth highest percentage reduction in Scotland.

Mr Fayers outlined that the biggest reason for delayed discharge was the lack of availability of care at home services, and that the biggest issue for that service locally was the ongoing issue of recruitment.

Mr Fayers stated that there were currently 49 vacancies in the care at home service, but added: “If we were able to to recruit to those 49 vacancies…that would enable us to significantly meet our current obligations around supporting those who have a discharge plan which is care back in their own home, the places where they stay.”

Chief executive of NHS Western Isles, Gordon Jamieson said: “…When you look at it nationally, it’s no good. There’s no dressing it up, it’s poor performance, whichever angle you look at it from.

“I know Nick [Fayers] said it’s five percent of all admissions or discharges, but the problem every single day is it’s impacting on at least 25 to 30% of the beds that are available. That’s the problem.

“There’s not a day goes by we don’t get contact at some point about the juggling that has to go on to accommodate people for routine and urgent care because of the presence of that number of people who are in the wrong place to be provided with care for their assessed needs.

“They’re not getting their assessed needs met in the most suited environment, and that’s every single day without fail now for about the last ten years – plus you could go back and count it even further than that.

“So this is a chronic problem that has acute periods every now and again, and it’s not only that it ladens decision making for our clinical teams with risk every single day, they’re having to make decisions and assess people who are borderline, or could possibly be discharged, because there are too many of the beds blocked.

“Not only that, the contingency beds are now becoming a far-too-permanent feature, and they are also laden with associated risks, and they’re only open because of the delayed discharges, they’re not open for any other reason.

“This is a serious problem, and it shouldn’t be underestimated because it is hampering progress in any other area, some of the things you want to do you can’t, because you’re being pressurized and strangulated all the time by the consequences of people being in the wrong place.”

In terms of mitigations of the issue, amongst other steps being taken, Mr Fayers highlighted ongoing work in recruitment to the care sector locally, as well as to the local Reablement service, and work was being undertaken to extend, where suitable, the use of ‘Hospital at Home’ services, and other measures to increase options for alternatives to admission.

On-going weekly meetings were also being undertaken, Mr Fayers added, as a ‘deep-dive’ into the cause of individual delayed discharges, and to identify potential future risk of delayed discharge for those being admitted to hospital.

NHS Western Isles has been approached for comment.