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England and Wales death rate rise linked to longer stays in hospital

Posted on 3/10/2017 by


Academics claim rising number of people forced to stay in hospital longer than necessary caused biggest year-on-year rise in mortality for 50 years

The sharp rise in the death rate in recent years could be down to the number of people being kept too long in hospital, inadequate social care and austerity-linked pressures on the NHS, academics say.

About 7,800 extra deaths a year in England and Wales are being caused by the dramatic increase in the number of people being forced to stay in hospital longer than necessary because they cannot safely be discharged, it is claimed.

A total of 39,074 more deaths than usual occurred between July 2014 and June 2015 – the biggest year-on-year rise in mortality for 50 years. Most involved frail, elderly people. That higher mortality rate has continued in the two years since. 

Although being in hospital should be a safe environment for older patients, senior doctors warn that their greater vulnerability to hospital-acquired infections such as C difficile, pneumonia and MRSA, and increased frailty due to lack of physical activity, can undermine their health. 

Academics who have studied death rates and the performance of the NHS and social care systems during that time believe that a fifth of the extra deaths in 2014-15 – about 7,800 in all – may have been directly attributable to patients being stuck in hospital.

“We demonstrate a positive association between the number of acute patients delayed in being discharged, and the cumulative amount of time acute patients were delayed, to the monthly number of deaths and mortality rate,” write the authors from Liverpool, Oxford, Glasgow and York universities in a research paper published in the Journal of Epidemiology and Community Health.

“Our results present evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health [and] may help explain part of the increases in mortality rates experienced in England from at least 2015 and onwards.” 

Dr Taj Hassan, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said: “Delayed transfers of care contribute to increased hospital mortality rates but we recognise that there are many other factors involved, such as the age of the patient and the severity of their illness or injury.”

Patients trapped in hospital beds they are fit to leave create “exit block” so hospitals become unable to admit new emergency cases fast enough, Hassan said. “We’ve previously estimated that exit block accounts for a significant number of avoidable deaths, with over 500,000 patients affected by it each year in the UK.

“Waiting to be discharged when ready to leave hospital also impacts on a patient’s health, for example through serious muscle wastage.”

Experts in older people’s care voiced deep unease at the report’s conclusions. Caroline Abrahams, the charity director of Age UK, said: “We already knew that being stuck in a hospital bed when you’re medically fit to leave undermines your chances of a full recovery. But this research raises the worrying question of whether in some instances it may shorten your life as well.”

Janet Morrison, the chief executive of the charity Independent Age, said: “These deeply worrying findings raise important new questions about the link between a surge in delayed discharges and the tragic human cost of those delays.”

The authors, led by Dr Mark Green of Liverpool university, said their results were “observational and associational”. Despite that, they said the issues raised deserved urgent attention because: “We have shown that the increasing prevalence of delayed discharges within hospitals occurred as mortality rates rose in England.”

NHS leaders have blamed the big increase in delayed transfers of care in recent years on local councils’ inability to provide packages of care quick enough for patients to safely leave hospital and go home or to other care, such as a nursing home. Local authority leaders point out that Whitehall-imposed cuts to town hall budgets had hit the provision of social care.

NHS England declined to comment. A Department of Health spokesman said: “Whilst the results of this research are limited, we are clear that no one should have to stay in a hospital bed longer than necessary.

“Both the NHS and local authorities have set ambitious targets to tackle this issue, supported by an additional £2bn of funding for social care from this government.”

Theresa May has pledged to bring forward a green paper on reforming social care and create a system that is sustainable long-term, given the ageing population and pressure on public finances.

Source: Guardian