Actions to reduce the risk to patients waiting in unacceptable circumstances in ambulances and Emergency Departments
As members of this community as well as health and social care service leaders, we are deeply distressed at the ongoing situation in our hospitals.
Although strenuous efforts are being made to alleviate the pressures, we have a serious capacity deficit which means too many people are waiting too long for care. Much of the impact of this is falling on frail and ill older people and on the staff caring for them.
Pressures on services are expected to intensify further after Christmas and into the early months of 2023.
The case for long-term investment and reform to effectively build capacity has been well made. Right now, however, we have to use whatever levers are available to us to reduce delays and prioritise patient safety.
HSC Trusts have been working intensively with Departmental colleagues on our ongoing response. It has been agreed that the following initiatives will be introduced across the system:
* Patients will leave hospital no later than 48 hours after confirmation they are medically fit for discharge and where a suitable placement which can meet their needs is available. There will be no cost to the patient or their family for this alternative interim placement and it will not impact on their place on any waiting list for their longer term option. Trusts and Care Homes will work closely together to make best use of any and all available capacity. This will include new shared arrangements for pre-admission assessment for care homes seven days a week.
* A maximum limit of three hours for ambulance handover will apply at all EDs. There is agreement in principle to further reduce this limit over the coming months, subject to review. In the interim, for ambulances waiting up to three hours for handover, it is agreed to maintain the focus on immediate release of ambulance crews to respond to immediately life threatening Category 1 calls.
* Maximum use will be made of available space in wards and throughout hospitals, to improve patient flow out of overcrowded Emergency Departments. This will also include, where appropriate, use of chairs rather than beds for patients medically fit to leave hospitals.
These are not steps that we ever wanted or indeed imagined having to introduce. They are not designed as a long-term solution, but as actions to reduce the risk to patients waiting in unacceptable circumstances in ambulances and EDs.
What we absolutely require is a long-term funding settlement and a health and care system which properly reflects demographic trends and is capable of meeting rising levels of demand.
In the meantime, we cannot passively accept the status quo, with all that it means for patient care and safety.