Little publicised or trailed, the Department of Health’s annual report and accounts were quietly released this week – on the face of it, not everyone’s cup of tea or preferred sun lounger reading.
But it serves as an important in-depth account of the state of the NHS in England.
The opening pages, inevitably, emphasise the positives – just as a corporate annual report would do. Half a million more patients seen in A&E than in the previous year, more than one million appointments booked or cancelled online, an increase in the NHS workforce, almost £1bn invested over five years in infrastructure to boost research.
But read on and the more difficult truths begin to emerge.
The report, covering the 2016-17 financial year, acknowledges that many of the key performance targets were missed, including the proportion of patients assessed or treated in A&E within four hours, which fell further below the 95% target to 89.1%.
There is understandable emphasis on the increasing pressures on the service with demand rising “above what would typically be expected from population growth and demographics alone” and the NHS delivering record levels of activity.
Areas for improvement
Looking for reasons for the drop in hospital performance, the report inevitably gets to the issue of delayed transfers of medically fit patients and the resulting bed shortages. The scale of the problem is underlined by the astonishing 24.5% increase in bed days lost because of these delayed transfers, to 2.3 million from 1.8 million the previous year. Hospitals were left full to capacity, sometimes unable to admit new patients.
It’s noted that local authorities are working with health leaders in each area to reduce the numbers of patients held in hospital beds because there is no social care package available. There is a bold statement that “this will be an area of improvement in 2017-18″.
The government has told NHS England that the delayed transfer number must be reduced to 3.5% of total bed occupancy by September. But it’s hard to see much progress in that direction so far.
An interesting analysis by NHS Providers, due out soon, highlights the continuing scale of the delayed transfer problem. The organisation points out that community hospitals have a far higher proportion of beds occupied by people who are fit to leave (20.8% in February) than the larger acute hospitals (5.1%).
Delayed transfers can occur when an NHS community facility is unable to take patients from acute care or when either type of NHS hospital can’t discharge patients because social care is not available.
The research also points out that in March this year there were more than three times as many delayed days due to “patients awaiting a care package in their own home” compared with April 2014.
NHS Providers concludes that the September target of 3.5% of beds occupied by patients whose transfer has been held up is looking highly unrealistic. That level has not been achieved for nearly three years and the latest quarterly current figure across all NHS hospitals in England was 5.6%.
The government has pumped £1bn extra into social care in England this year in part to help tackle the causes of the delayed discharges of patients from hospitals. One of the aims is to free up NHS beds to cope with rising emergency admissions and the backlog of routine operations.
But with local authorities pointing out that there are many other social care issues to tackle with the money, it’s still not clear whether the new funding will make a significant dent in the delayed transfer numbers.
It’s the height of summer and NHS leaders and politicians are preparing for their holidays. Their minds will not be on bed occupancy and social care.
The Department of Health report and the NHS Providers analysis will be parked up in office in-trays and inboxes. But when they return there will be some serious thinking to do as winter pressures begin to loom.