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British Geriatrics Society

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British Geriatrics Society poll suggests icy winter will bring delays

As the cold weather continues throughout the UK, it underlines warnings of problems in caring for the elderly from the British Geriatrics Society (BGS). A survey of BGS members has predicted that the third consecutive cold winter currently faced by Britain could mean patients will face many more delays than were experienced in the previous two winters (2008/9, 2009/10).1

ambulance2Over 80% said that a third cold winter would bring ‘some delays’ or ‘lots of delays’ in discharging patients from hospital to a care home, rehabilitation services or social services. Between 21% and 39% thought the number of delays would be greater than the previous two years to these three discharge destinations. Less than ten per cent thought that there would be ‘no significant delays’ this year.

Asked whether their hospital had a plan to manage the increased pressure that could result from a third cold winter only two in five said yes and a quarter said no. People were questioned about the impact that current plans for the redevelopment or reconfiguration of their service or department may have on their ability to cope with winter pressures in the future.

Three in five said their service or department was facing reconfiguration, 46% were facing contraction, 17% were merging and 17% said they were expanding. Forty-two per cent said the impact of the changes would be ‘mostly negative’ against ten per cent saying it would be ‘mostly positive’.

Dr Finbarr Martin, Consultant Geriatrician at Guys and St Thomas’ Hospital and President of the BGS, predicted towards the close of 2010 the consequences which continuing cold weather might have: “there will be significantly greater delays in discharging patients from hospitals and this could have major impacts for the quality of care older people receive”.

Martin pointed out that while “the survey response is small it must be remembered that cold weather affects older people disproportionately than the general population, for instance, 90% of winter excess deaths are of people aged over 65.[2] As we have an ageing population, we need to adapt and better integrate our services so that we are able to deliver high quality and efficient care”.

Survey results
The BGS survey got 48 replies from members; the vast majority of respondents were consultant physicians in geriatric medicine.

Q1: What was the impact of the last two cold winters (2008/9, 2009/2010)

Past two winters (%) Expected this winter (%)
Elderly care services 81 88
Medical wards 94 90
Temporary wards 42 58
Surgical wards 73 65
Other 2 23

Q2: Where were older people treated in your hospital in the last two years and where will they be treated this winter? (Percentages of respondents ticking each location. This does not signify the percentage of older people being treated in those locations):

Past two winters (%) Expected this winter (%)
Elderly care services 81 88
Medical wards 94 90
Temporary wards 42 58
Surgical wards 73 65
Other 2 23

Q3: Were there delays to discharge to the following places in the last two cold winters and do you expect delays in discharge to the following places this year if it turns out to be a third cold winter? (Where ratios do not add up to 100%, the balance is accounted for by no response).

% of ‘no significant delays’ in previous winters (expected this year) % of ’some delays’ in previous winters (expected this year) % of ‘lots of delays’ in previous winters (expected this year)
Home 6 (10) 58 (56) 33 (29)
Rehab Services 33 (29) 56 (46) 31 (44)
Care home placement 4 (4) 44 (31) 48 (58)
Social services 2 (2) 48 (33) 46 (56)
Other 4 (6) 17 (13) 4 (4)

A number of free text comments were made with relation to this question. These included:

  • Inappropriate pressure to move patient to rehabilitation wards when in need of acute services.
  • Nearly drowning in numbers.
  • Multiple bed moves increasing risk of HAIs [hospital acquired infections] spreading.
  • Safari ward rounds to multiple areas lead to prolonged length of stay esp[cially] when ward were temporary and therefore sat feed with nurses/admin unfamiliar with the social services paperwork needed to set up or even restart care.
  • A lot of inappropriate boarding.
  • Low medical staffing due to sickness.

Q4: Has your hospital/dept got a plan in place for dealing with the winter pressures?

  • Yes (40%)
  • No (25%)
  • Don’t know (35%)

Q5: With the NHS being under significant pressure, one can expect a raft of policy initiatives, reconfiguration and financial pressures. Are there current or future plans to do any of the following in your service/department? (respondents ticked any box which applies, so this does not add up to 100%)?

  • Reconfiguration (60%)
  • Expansion (17%)
  • Contraction (46%)
  • Merger (17%)
  • Don’t know (19%)

Q6: With reference to your answer to question 5, will these changes have a positive or negative impact on the care and treatment of older people that your service/department deliver over the winter months?

  • Mostly negative 42%
  • No difference 4%
  • Negative and positive 31%
  • Mostly positive 10%

Q7. Any other comments? Below is a selection of comments given in answer:

  • Despair at times.
  • Our Trust is committed to removing older people’s services from the main hospital but has no clue how to do it. A number of geriatrician‐initiated projects are going on with the aim of connecting hospital and community services but while these look promising they are at the mercy of future funding decisions.
  • With continuous reduction in medical bed numbers in hospital but without any real increase in social care provision e.g. home help, district nurse, meal on wheel, care home place etc. I am certain that elderly care will suffer and the idea of care closer at home/admission avoidance is just a “dangerous” practice.
  • Unbearable sustained multi‐level pressures.
  • It is strange that the coming of winter every year is such an unexpected surprise.
  • Social services however have already stated that they are unable to provide the usual level of funding for care home placements; limiting this to 3 a month for the region! This has already begun to impact the acute services, as more patients await care home placement in acute wards.

Contact

Tom Thorpe
email: tomthorpe@bgs.org.uk

References

  1. British Geriatrics Society poll suggests a third icy winter will bring delays, (BGS Press Release, December 2010) Access online: http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1131:british-geriatrics-society-poll-suggests-a-third-icy-winter-will-bring-delays&catid=6:prindex&Itemid=99
  2. Aggregate of figures from ONS (England and Wales), GROS (Scotland), and NISRA (Northern Ireland), 2008, quoted in Help the Aged, Older people in the United Kingdom (May 2010)

Published on: January 13, 2011

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