Exclusive: Hidden epidemic 'dwarfing harm by hospital superbugs'

Leading geriatrician Ian Sturgess told HSJ potentially in excess of tens of thousands of patients, largely older people, had been harmed by what he termed “hospital acquired functional decline” in the NHS over the last decade.

The NHS must “wake up [to] the hidden epidemic of harm”, which he said was troubling all developed health systems. He said an “inherent ageism” which assumes poor outcomes for older people was prevalent and raised concerns the NHS could also face legal action from patients harmed in this way.

Dr Sturgess, who developed the stranded patient measure NHS England is now using to cut patients’ length of stay, also raised fundamental concerns about the approach taken by both senior policy makers and clinicians. He said NHS England’s current drive to free up beds, which he is advising on, risked “perverse incentives”.

The former senior clinical leader in the NHS national emergency care improvement programme is now an independent adviser who has worked with more than 150 hospitals worldwide, including many in Australia and New Zealand.

The harm done by deconditioning was comparable to the impact of hospital acquired infections C difficile and MRSA had on the health service 20 years ago, he said, but stressed deconditioning harm was far more widespread.

“Many of our care services are full of people who have suffered from avoidable deconditioning.” Between 50 and 90 per cent of delayed transfers of care patients have suffered deconditioning, he estimated. “Delayed discharges are the surrogate marker for avoidable deconditioning. I’m not saying every single one, but a significant amount are.”

He supported NHSE’s decision to focus on cutting super stranded patients – those who have spent more than 20 days in hospital to free up 4,000 beds – but said a more holistic approach was required.

”It has to be done in the right way,” he said. “The [stranded patient metric] is a measure for improvement – not a measure for judgement. As soon as you use it as a measure for judgement, then you create perverse behaviours.

“There is a risk that the current approach could lead to perverse incentives. It could lead to the opening of community beds and people being parked there.

“When measuring the stranded and super stranded metric, you need to measure three other key metrics: quality, readmission rates, and post-discharge community and social care costs. You have to measure them all together, in what is described as a virtuous cycle of metrics.”

He also described having medically fit for discharge wards – something many hospitals have adopted –  as “the worst thing you can do”. 

He added: “Firstly, they are full of patients which are deconditioning. And secondly, what message does that give to the staff who discharged them? ‘I don’t have to sort out the discharge, do I? I can pass it onto somebody else.’”

A leading clinical negligence lawyer told HSJ there was a theoretical legal risk, but that a large number of claims against the NHS because of deconditioning was unlikely.

Bevan Brittan senior partner Joanne Easterbrook said: “You can see the potential for a claim if there has been a personal injury in theory. But there are many factors in play both in terms of whether people pursue legal action and in terms of the legal process.

“There could also be scope for a public law challenge via a judicial review arguing there are systemic problems with the way the NHS is looking after patients. But, again, I am not convinced this would succeed either as the NHS could argue that it had reasonable processes and governance in place and was doing its best within its resource constraints.”