Exclusive: Hospitals to miss flagship winter target

NHS Improvement tasked trusts last spring with reducing the proportion of patients who had been in hospital for three weeks or more by a quarter, by the end of December.

NHSI data obtained by HSJ shows that trusts had freed up 1,850 beds by the end of November – making it highly unlikely they would go on to hit the 4,000 target in the subsequent month.

The unpublished data, released under the Freedom of Information Act, shows just 25 of 131 acute trusts included had met their target to reduce the length of stay of so-called “super stranded” patients by 25 per cent, as of November, just a month before the target deadline.

While falling short of the ambitious target, the figures indicate that trusts’ efforts did create significant additional capacity over winter. 

HSJ analysis of the data suggests that in November 2018 around 17 per cent of the 103,519 total beds open at those providers were occupied by long-stay patients, compared to an average of 19 per cent during 2017-18.

NHSI and NHS England said in a joint statement: “More beds have been available for those who need them most this winter as a result of significant reductions in the number of patients staying over 21 days compared to last year.”

Struggling to make headway

Some trusts in particular appear to have struggled to reduce super stranded patients – with 39 showing an absolute increase in the number of super stranded patients in November compared to their baseline average across 2017-18.

HSJ has also analysed how the share of each trust’s total bed base occupied by super stranded patients changed between 2017-18 and November 2018, according to the data from NHSI, to take account of any increases or reductions in bed numbers.

Out of the total 131 acute providers, 47 saw an increase or no reduction in this proportion – seven trusts saw a rise of more than four percentage points.

The three largest rises were at Barts Health Trust (7.6 percentage points), Countess of Chester Hospital Foundation Trust (7.3 percentage points) and Lancashire Teaching Hospitals FT (6.7 percentage points).

Conversely, other trusts showed large cuts in line with the target. The three trusts with the highest proportion of long-stay patients in 2017-18 all managed cuts of over 20 percentage points. These were: University Hospitals Birmingham FT (30 percentage points), Homerton University Hospital (20 percentage points) and Wirral University Teaching Hospitals (21).

There is significant variation between trusts, which experts stressed should be interpreted with care, and underlines the different approaches required in different areas (see below).

UHBFT had the highest proportion of long-stay patients in 2017-18, with a huge 522 of its 1,085 beds occupied by super stranded patients, according to the data. Meanwhile just 6 per cent of Barnsley Hospital FT’s beds were occupied by super stranded patients in the same period.

Proceed with caution

The trusts named were approached but most did not comment. Barts Health disputed the figures but accepted it was “short of the new national standard”. A statement said: “Validated data for Barts Health shows the number [super stranded patients] was… 364 in November… a reduction from the baseline of 408 in line with national expectations, although they are still short of the new standard. We are working hard to further reduce the numbers of long-stay patients, but they do tend to be sicker people requiring more complex treatment and therefore take longer to discharge.”

Other senior figures told HSJ that measuring super-stranded patients was useful, but figures should be interpreted with caution.

Glen Burley, chief executive of a group of trusts comprising South Warwickshire FT and Wye Valley and George Eliot Hospital trusts, said super stranded patient numbers were a good flow measure.

But he told HSJ: “Some acute providers have community beds, and other beds with naturally longer length of stay like rehab units, included in their baselines, and others do not. The super stranded data for purely acute providers will look significantly better.

“So, comparing one trust with another trust is not the same as comparing one acute hospital with another acute hospital. The focus should be on the acute setting, because it is here where evidence shows that the most patient harm is done if patients stay longer than necessary.”

Leading geriatrician Ian Sturgess, who developed the metric and has been advising NHS England on its use, also raised concerns too many trusts were “focusing on ‘let’s just shift the number’, which means you can end up hitting the target, but missing the point”.

He explained hospitals must also ensure they were seeing more patients returning to their homes, simple and timely discharges, and a stead or falling readmission rate.

He added: “As a consequence of eliminating hospital acquired functional decline your long-term health, social care and community health care costs fall.”

National data

NHSI disclosed to HSJ the daily national number of super stranded patients in 2017-18, the target daily average for December, and the daily average delivered during November. The figures are shown below:

Baselines and targets	Number of long-stay patients
Baseline daily average in 2017-18	19,302 super stranded patients
Target average for December 2018	15,302 super stranded patients
Total delivered average in November 2018	17,452 super stranded patients
Shortfall to target	2,150

The NHSI monitoring information is based on secondary uses service data and is not comparable to weekly sitrep data published by NHS England, which also logs super stranded patients because the SUS data is based on long-stay patients who have been discharged, NHSI told HSJ.

This article was updated at 16:45 on 13 February to include a statement sent after the publication deadline by NHSI and NHSE.