Hospital bed blocking drops in Cornwall from record high

Bed blocking at hospitals in Cornwall has fallen from a record high of over 240 people 'trapped' on wards unable to find ongoing care packages last July to 85 yesterday (May 3). Royal Cornwall Hospitals Trust (RCHT) chief executive Steve Williamson said it was "really positive" news with significant work under way to create additional capacity throughout the year.

The Royal Cornwall Hospital in Truro has long been hampered by beds being blocked by patients who are medically fit to be discharged but have no care packages available. The backlog means delays for people attending the emergency department (ED) and awaiting routine operations.

Mr Williamson was speaking at a RCHT board meeting today (Thursday, May 4), which heard that the amount of 'delayed discharge' patients across Cornwall's hospitals stood at 85, just ten above the agreed trajectory of such patients occupying hospital beds in May.

He said: "This is a significant improvement compared to our prior position. We would all want to see that trend continue. If this was to continue that would potentially put us in a position where we could be on trajectory for our delayed discharges later this month."

The chief executive added that "significant work to create additional capacity" included an extra 40 support packages for patients needing care in their homes by the end of June and enabling extra capacity at community hospitals.

Trust chairman Dr Mairi McLean welcomed the news: "After such a sustained period of feeling real difficulty with everything it is good to hear some good news and some movement. It represents so much hard work and care on the part of staff and volunteers."

It isn't all good news, though. The trust's performance against the emergency department four-hour standard averaged at just over 41% against the national standard of 95%. The county's only ED at Truro's Royal Cornwall Hospital continued to be in the worst ten national performers and saw 1,000 more patients in March 2023 compared to March 2021, and 500 more than in 2022.

Mr Williamson pointed out that urgent treatment centres (UTC) and the Cornwall Foundation Trust's minor injury units continued to perform well against the four-hour standard, although staffing vacancies and sickness had resulted in early closures and in the case of West Cornwall UTC, the continued overnight closure of the unit.

He said the strongest challenge remained ambulance handover times. His report to board members, written before the drop to 85 delayed discharge patients, stated: "The impact of less hospital inpatient available bed capacity than planned on ambulance response times (category 2 mean response times worsened to 105 minutes in March) remains a major concern, as does the impact on time-critical care pathways such as those for people who have had a stroke or fractured neck of femur.

"Whilst we have seen periods of reduction in ambulance handover delays, sustainability of that improvement has not been possible in the absence of a similarly consistent reduction in the number of medically fit patients awaiting discharge. As a result, we still have more than 100 escalation beds and spaces open, are regularly flexing our discharge lounge and same day emergency assessment areas for bedded inpatients and have had to prolong the use of one ward at St Michael's Hospital to care for patients who are awaiting discharge."

More than 700 people were left waiting for over 12 hours in Cornwall's emergency department, the latest figures – for March – have shown. Last month, little over half of people attending ED at Treliske, Truro, were seen within four hours. The NHS has targets to see 95% of patients within four hours. However, in March, just 41.3% were seen within that time.

That figure doesn't include other emergency-type departments though, such as walk-in centres or Cornwall's two urgent treatment centres – at Barncoose at Redruth and West Cornwall Hospital at Penzance – or the several minor injuries units at community hospitals. When they are included the average improves to 76.9% of patients, which is still behind target.

Mr Williamson noted that RCHT's performance against the cancer standards, while not yet back to where the trust would want it to be, is improving and remains better than that of many other trusts. He welcomed next month's opening of the new MRI and oncology unit at Treliske: "Sitting alongside the Trelawny Wing main entrance, the unit will transform inpatient and outpatient cancer care and completes the first part in the jigsaw as we vacate space for the future Women and Children's Hospital build."