More people could be spending the time between Christmas and new year in hospital in parts of England this year than at any time in the past decade, as NHS trusts struggle to find social care places for patients medically fit for discharge.
The latest figures for December to date show an average of 94,200 patients were in hospitals across England, more than 93,000 of them in acute settings, the highest in seven winters.
Hospitals in the south-west, south-east and north-west, the areas with the highest proportion of medically fit patients who cannot be discharged due to an acute lack of social care, are taking care of a record number of patients.
The chief executive of NHS England, Amanda Pritchard, admitted the health service could be facing the “most challenging winter in our history”, even worse than the height of the pandemic.
In a Christmas thank you message to staff she said: “I always thought that, difficult as those initial waves of Covid were, and they really were, actually it would be dealing with the ongoing pressures, that could be even tougher – that combination of recovering services whilst also dealing with continuing Covid and everything else that winter throws at us.
“We’re facing record demand for many services from GP services, to mental health services and of course, urgent and emergency care. But despite these pressures, NHS staff are rising to the challenge every single day.”
The figures, which reflect the situation in the weeks to 18 December, show the scale of the challenge facing trusts, which were asked to undertake a “rapid discharge of medically fit patients” before last week’s ambulance strikes.
The NHS is experiencing a winter of discontent, with strikes by nurses and ambulance staff and multiple pressures affecting the service, including record ambulance delays, ever growing waiting lists and thousands of beds required for flu patients, as the virus has begun circulating widely after the Covid pandemic.
Across England 13,697 patients were ready to be discharged but could not be sent home or into other care settings in the week to 18 November, according to the NHS, equivalent to around one in seven people in hospital.
In the same week last year that figure stood at 10,694, meaning the number has risen by more than a quarter (28%) according to figures provided by the NHS.
However, the south-west – where more than one in five patients are stuck in hospital despite being medically fit to leave – is particularly badly affected, with 44% more patients taking up beds than the pre-Covid average.
Almost two-thirds (64%) of the region’s 14 acute hospital trusts had higher occupancy rates than the English average in December, while close to half experienced their highest levels of occupied beds for at least the past decade.
An NHS spokesperson said: “There is no doubt the NHS is under considerable pressure – the latest figures show 19 in 20 beds occupied amid rising numbers of flu cases in hospital and that’s on top of record A&E demand, increasing staff absences and over 13,000 patients each day in hospital despite being medically fit for discharge.
“Thanks to the efforts of staff and our recent drive on this there has been a reduction in the number of delayed discharges within NHS control, and the NHS continues to work closely with social care colleagues to ensure as many patients as possible can make it home in time to spend Christmas and new year with their loved ones.”
The British Medical Association doctors’ union said patients deserved better. Prof Philip Banfield, its chair of council, said: “Christmas should be a time people can spend with their families and loved ones and the thoughts of doctors and nurses will be with those who remain in hospital.”
He added: “With years of chronic underfunding and dreadful workforce shortages across the NHS and social care, this sadly comes as no surprise. There simply isn’t the capacity in the system to efficiently discharge people who could otherwise be cared for at home or in other settings.
“In 2023 the government can’t afford to bury its head in the sand, ignore healthcare workers and expect patients to put up with the NHS, once the envy of the world, collapsing around them.”
The NHS Confederation, which represents hospitals, predicts fewer patients will be kept in beds this Christmas than the figures suggest.
Its chief executive, Matthew Taylor, said: “There will undoubtedly be patients stuck in hospital this Christmas due to unavailability of social care packages, where they could otherwise be moved back home or into a residential setting.
“Some NHS leaders are telling us today that the strikes have led to a slowdown in patients being discharged from hospital. The strikes aren’t helping, but this has been a longstanding issue.
“That said, significant and effective preparatory work went into discharging those who no longer need to be in NHS beds ahead of the strikes. Although there has been a slowdown since the strikes, we think and hope that the situation may be better than what is outlined in these latest figures.”
But Taylor said more investment in social care would be needed to help free up hospital beds in future. He said: “The NHS and social care are working closely together to improve discharge rates but this is an ongoing challenge.
“We welcomed the government’s recent extra investment in social care, but that now urgently needs to be converted into more care packages for vulnerable people who desperately need social care support. Otherwise they will continue to suffer and the NHS will continue to have too many patients occupying beds that don’t need to be stuck in hospital.”