Heart of England A&E failings blamed on bed-blocking crisis
Birmingham’s largest hospital trust has blamed a bed-blocking crisis for its failure to hit A&E targets, which have put it in special measures.
Troubleshooters were called into Heart of England NHS Foundation Trust by overseeing body Monitor when it left scores of emergency patients untreated for more than four hours for the third winter in a row.
But the trust’s management, which run Heartlands, Good Hope and Solihull hospitals, has joined University Hospitals Birmingham Foundation NHS Trust in a wrangle against Birmingham City Council calling for £1.5million worth of fines because the local authority has failed to remove healthy patients blocking beds.
They believe delayed discharges – where mainly elderly patients are stuck for months in a hospital bed for no other reason than that they had nowhere to go or no care package – is putting a strain on their finances and ability to get patients seen quickly.
A Heart of England Trust spokeswoman said: “Delayed transfer of care is an issue for all hospitals as beds become occupied by those who no longer need to be in hospital.
“This consequently prevents new admissions getting to the right bed and a domino effect contributes towards delays in the system and accident and emergency.
“The trust and Birmingham City Council are working closely together to reach a mutual agreement that is best for patients, however if an outcome is not agreed then the trust can legally fine the council for those delayed discharges.”
Monitor chairman William Moyes said there had been a “significant breach” of four-hour A&E waiting time targets at Heart of England in January, giving the trust the worst risk rating of ‘Red’.
It comes as the city council was shamed by the Audit Commission with a ‘red flag’ for poor performance of failing to address an unacceptably high number of delayed hospital discharges.
A Comprehensive Area Assessment found that up to 150 patients were blocking beds in city hospitals. Five years ago, a pioneering agreement was drawn up in Birmingham which would see the NHS forego charging the city council £100 per day for each patient deemed to be unnecessarily blocking a bed because no residential care had been found for them.
This rule was set out in the national Community Care (Delayed Discharges) Act. Instead, NHS trusts agreed money would be better spend if the council invested the huge sums put aside for these fines into more social workers, care home places and services that would prevent bed-blocking.
But the Foundation trusts which run the lion’s share of hospitals in the city – Queen Elizabeth, in Edgbaston; Selly Oak; Good Hope, in Sutton Coldfield; and Heartlands, in Bordesley Green – appear to have suddenly lost faith in the system, withdrawing from the agreement with the city council and now demanding £1.5million in payments instead.
Peter Hay, chief social care officer at the council, hit back saying the hospitals have not made any notification of ending the agreement and are now trying to be “paid twice” in taxpayer’s money as the reins tighten on public sector funds. A Freedom of Information request by the Birmingham Post has revealed the extent of delayed discharge numbers and amounts invoiced.
The inquiry unveiled that University Hospitals Birmingham NHS Foundation Trust had raised invoices for £211,000 for April 2008 to March 2009 and £253,600 for April to October last year. Heart of England invoiced the council for £577,000 for the period of April to July last year.
A further £500,000 is believed to have also been invoiced since then. The total number of delayed discharges up to January 17 stood at 116 across the city.
Average bed-blocking figures over the winter have been well above 100 for the past few years, reaching 162 in February last year.
Last November and December, hospitals were forced to cope with averages of 146 and 135 patients respectively clogging up beds.
Mr Hay said: “The city council and the PCTs take the view that the local agreement on investment remains in place and are looking to resolve these issues. PCTs already pay hospitals for extended bad stays and we all want to make effective use of public money. It was a surprise when the invoices were put in. I have never had correspondence from these two trusts to say they were coming out of the agreement because I would have taken money out of the system to pay the fines.
