Introduction
Today NHS England published another release of its weekly winter situation reports, providing valuable insight into activity across emergency care and hospitals from 16 to 22 January.
The data this week highlight the enormous efforts of staff, who are working under immense pressure. Although this week saw an increase in arrivals to A&E, handover delays reduced, with fewer hours lost to delays despite this increased demand. However, the number of medically fit patients remaining in hospital remains a concern and continues to contribute to high bed occupancy levels.
Winter situation report (16 – 22 January)
A&E closures and diverts: There were no A&E closures again this week. There were a total of 19 A&E diverts this week, one more than the week prior.
Adult critical care: Bed occupancy dropped this week to 80.6%, down from 82.6% last week. This is above levels seen this time last year (74.5%).
Ambulance arrivals: A total of 77,937 patients arrived by ambulance in the latest week. This is an increase of 8.2% since last week and a decrease of 8.8% compared to the same week last year.
Ambulance handovers: 20.2% of ambulance handovers were delayed by 30 minutes or more, a decrease from 23.4% last week. 6.6% were delayed by 60 minutes or more. This is a decrease from 8.9% last week. A total of 10,170 hours were lost to ambulance handover delays, another decrease from the week before.
Diarrhoea and vomiting (D&V): The number of beds closed due to D&V and norovirus has increased this week, with an average of 473 beds closed per day. This is up from 417 last week and above levels seen this time last year (241).
Discharges: There were an average of 22,983 patients each day who no longer met the criteria to reside, a decrease of about 3% (689 fewer). However, compared to last week, a similar proportion of patients remained in hospital this week, with 59% (or 13,566) staying in hospital.
Flu: This week the average number of general and acute (G&A) beds occupied by flu patients each day decreased by 41% to 1,893. An average of 141 critical care beds were occupied by flu patients each day this week (36% fewer than the week before). Compared to the same week last year, the average number of G&A beds occupied by flu patients each day has increased by 5,421% (1,859 more). The average number of critical care beds occupied by flu patients has increased by 7,508% from the same time last year (139 more).
G&A beds: There were an average of 101,473 G&A beds open each day – 5.1% higher than the same time last year (4,908 more). On average each day, 212 beds were unavailable and void to non-COVID infections. Average bed occupancy remains high at 93.8%, although slightly down from last week (94.2%). This is 2.2 percentage points higher compared to the same week last year.
Long stay: The number of patients staying in hospital longer than seven, 14 and 21 days has fallen this week, by 1.9%, 3.0% and 1.7% respectively. Compared to the same time last year, the numbers of patients staying in hospital for longer than seven, 14 and 21 days have all increased (up by 11.6%, 11.9%, and 11.1% respectively).
Neonatal intensive care beds: Occupancy has remained relatively stable from last week and is at 64.8% (was 65.1% last week) and down from 70.2% the same week a year before. The average number of care beds open is at 1,705, two beds fewer than last week.
Paediatric intensive care beds: Occupancy has decreased this week to 81.7%, down from 86.1% last week and it's the lowest it's ever been this winter. However, this is still higher than the same week last year (75.2%). The average number of care beds open has remained the same at 356.
Respiratory syncytial virus (RSV): An average of 31 paediatric beds were closed this week due to RSV symptoms, down from 47 last week and up considerably from four last year.
Staff absences: There were an average of 49,260 total absences each day this week, of which 8% were COVID-19 related (4,144). The total number of staff absences decreased from the week before and so did the proportion of COVID-19 related absences, from 10% the week before.
Our view
This week's data continue to depict trends observed in previous weeks, illustrating the challenges facing the NHS throughout this tough winter period. While adult G&A bed occupancy dropped slightly this week, it remains extremely high at around 95%. Although the number of patients in hospital with flu continued to follow a downward trend, levels remain considerably greater than this time last year.
However, this week has seen some positives which will hopefully continue in the coming weeks; staff absences have fallen, as well as the proportion of COVID-19 related absences. In line with this, the number of patients with COVID-19 in hospital has also reduced, and we are seeing fewer patients staying in hospital longer than seven, 14 and 21 days. These figures demonstrate how trusts are seeing some signs of improvement despite the challenging circumstances exacerbated by seasonal pressures.
Helping to aid hospital discharges for those living with a mental illness
Harvey Crawford, policy manager at Rethink Mental Illness, discusses the importance of residential nursing services which is helping to aid hospital discharges for those living with a mental illness.
Ensuring that people who need inpatient care can access this locally is vital. Too often, beds are unavailable because patients no longer receiving clinical benefit from being in hospital cannot leave, and inability to meet their social care and housing needs is the factor preventing this in 70% of cases. Residential nursing services and other types of supported housing don't just prevent delayed discharges but cost the system much less than an unnecessary extended inpatient stay.
In Derbyshire, Rethink Mental Illness runs Shipley and Derwent Lodge. These are both 16-bed residential nursing services for anyone over 18 with a primary diagnosis of mental health. The service was founded in 2002 and has since 2021 been pre-commissioned and paid for via NHS winter pressures funding.
A patient's journey into the service begins when they are clinically ready for discharge. If there are additional barriers to discharge, these will be discussed with the patient in hospital when they are informed about this step-down service. With consent, clinicians can make a referral, and if they meet the criteria, service staff meet the patient on the ward. Ensuring safety needs are met, the patient can then be discharged to the service. Depending on availability, patients usually have a choice of which facility they would prefer.
Although classed as a nursing service, the service is built around the principle of independent living. Residents can access a communal kitchen to make their own food, and have the choice to engage in various activities offered by the service. Alongside this, they receive therapeutic one-to-ones with a nurse, who also supports them with medication.
The service has strong links with a range of statutory, voluntary and community partners, including community mental health teams, social care, Derbyshire Recovery Partnership, Phoenix Drug and Alcohol Services and wider housing services. During their maximum 12-week stay in the service, the service will work with these partners to ensure individuals are able to access support in their local area.
Staff emphasise the importance of considering someone's eventual exit from the service from when they arrive. The Shipley Lodge service even has a flat attached, which can aid with making this step down. Residents are supported to consider goals for life beyond the service, and staff take action, including making referrals into social care services four weeks before departure, to ensure they move on with access to relevant care and support. Those with their own property are usually offered opportunities for social leave at home ahead of leaving the service to see how they get on.
The service's relationships with the NHS, particularly local mental health hospitals and the community mental health team, are crucial. Service staff attend weekly bed management sessions led by the care co-coordinator, and twice a week attend clinically fit-for-discharge meetings as part of a multi-disciplinary team of professionals working together to ensure safe and timely discharge from inpatient care.
A former resident of Derwent Lodge said: "I liked it here because the environment is peaceful. The staff are great too – respectful, helpful and easy to speak to. The gains in self-confidence and better understanding of my mental health helped me to reduce and finally stop taking antipsychotic medication. I haven't experienced any suicidal thoughts. I continue to take anti-depressant medication – this helps me control my mood and emotions. I also have taken the lead in managing my own medication regime. After spending 12 weeks, I was able to return home to my family under the care of a consultant psychiatrist."