[ What links poor staffing in the care sector to lower ambulance numbers and deaths from overcrowding in A&E? ]

8th December 2021

In our last two articles, we’ve talked about a few different issues affecting the UK healthcare system. First we looked at the risks of overcrowding in A&E, and the 160,000 people per year coming to harm because of a lack of available ambulances. Then our newest team member, Meg, took us on a tour of her experiences working in the care sector, and how low staffing is affecting quality of care for patients and quality of work for staff.

At SQ, we think of the NHS as a people-led system; one that we can improve by using data to optimise the experience for every person involved. This is true not only at the level of a single hospital or clinic, but it is also true across the entire national (and international) network of services. We can often think of NHS services as quite separate – going to visit the GP feels very different to an A&E department; and care homes feel like another world again. But the truth is that all of these systems are interlinked and issues in one area will cause knock-on effects across the whole network of healthcare. 

Take the example of a 90-year old woman in Manchester, who “felt imprisoned in hospital for a month” , after arriving at Salford Royal Hospital on October 28th. While the nurses on her ward felt she’d be more comfortable recovering at home, a lack of social care professionals meant that she couldn’t get the support she needed to be able to leave. In fact, there was a region-wide shortage, revealed by Greater Manchester health officials last week.  

People who are deemed “medically fit for discharge” are being kept in their hospital beds. Leaders have stated that they are unable to be released for a variety of reasons such as:

  • Covid, which caused some patients’ conditions to become more serious, meaning more time in hospitals. 
  • More patients needing more support after discharge. 
  • Capacity/capability of staff to discharge a patient due to lack of a level of seniority (which is needed to discharge patients confidently and safely). 
  • Where the patient is going to go safely. 

However, medics are noting that a major reason keeping people from being discharged is a staffing shortage in social care. The inability to discharge patients is causing hospital beds to be overcrowded and “more than 90 percent full”. 

97% of care workers say their homes have shortages, one in three report staffing levels are already “dangerously low” and it’s getting worse. Unison Union reports that the ‘Double-jab’ rule risks care collapse. Care staff who refuse covid jabs have been banned from entering care homes in England since 11 November. Unison general secretary Christina McAnea states: “Care workers are burnt out from the pandemic, exhausted from covering gaps and fed up with low wages. Tens of thousands could lose their jobs this week because of the ‘no jab, no job; rule. This is nothing short of a nightmare”

All of these issues have had a huge effect on the elderly woman at Salford Royal Hospital. She used to receive three visits per day from social care workers when she was in her own home, but that offer was quickly rescinded a few days into her most recent admission to Salford Royal Hospital. As one of her two daughters explained, “My mother is blind and deaf, she’s a fall risk so she does need help at home. She has been admitted to hospital on several occasions, typically for falls. During one of her stays, she caught Covid-19 and had to remain in hospital. “On October 28, she was admitted again with what was thought to be a mini stroke. Around four days later, she was ready for discharge, but 48 hours after she went into Salford Royal her care package had been stopped. “Even the nurses are saying it’s not doing her any good being there, and the doctors tell us the best place for her is her own surroundings. “Every time she gets stressed she suffers from delirium. She’s so frightened of going into hospital, the admissions set her off again.” 

But it isn’t only the old lady trapped in a hospital who suffers, it’s also the person in need of inpatient care who has to wait longer for a bed. It’s the paramedics stuck in the ambulance outside the hospital waiting for space for their patient to be admitted, and the emergency patient who that ambulance can’t get to in time because of the drop-off delay. 

The patients in these situations are feeling helpless and trapped, or suffering permanent harm due to delayed treatment. Something needs to change. We cannot keep thinking of healthcare services in isolation – we must respect all of our healthcare staff and the role they play in keeping the system flowing smoothly. Perhaps if it was clearly understood how lack of care staff affects everyone, not just those in the care homes, we would provide better support and compensation for those staff. For now, we will keep doing our bit to understand what is happening in every area of healthcare we go into, using data to build a clearer picture of how the whole system fits together. 

Kathryn White
Kathryn White
Head of Product & Innovation