Nearly a quarter of beds at Norfolk's biggest hospital are occupied by "stranded" patients who have been there for more than two weeks, contributing to ambulance handover delays of up to nine hours because no hospital beds are available.

A shortfall of 1,000 social care staff in the county is causing a chain reaction to run backwards through the NHS, an investigation by this newspaper has revealed.

With hospitals unable to move patients on, planned operations are being cancelled for lack of beds, as has happened twice to a delivery driver from Felthorpe who has waited a year in agonising pain only to have appointments cancelled with less than 24 hours notice.

The blockages also affect entry into hospitals. This newspaper has learned that last weekend 27 ambulances had to queue outside the Norfolk and Norwich University Hospital (NNUH) to offload patients, one of whom waited on board for more than nine hours.

It comes after two patients died in ambulances in hospital car parks in the region last month, prompting NHS England to write to hospital bosses insisting they stop using ambulances as "additional emergency department cubicles".

Too few care workers means too few care beds

According to an industry report, in financial year 2020/21 the care sector in Norfolk included approximately 16,000 frontline care workers, but needed 17,000.

Christine Futter, a director of the Norfolk Care Association, explained: “It is about staffing capacity. The reason the beds can’t be filled is because they don’t have the staffing capacity to manage safely.

“You might have 40 beds but you may not be able to fill five to ten of them because you have not got staff to manage that safely.

“The issue is there aren’t enough staff, recruitment is incredibly difficult - in all sectors.

“It’s an unemployed person’s market at the moment and there is a degree of responsibility in that job that you don’t have in others, like retail for instance.”

Too few care beds means patients can’t leave hospital

If an elderly person falls at home and breaks their hip they may need to move into a care home, either temporarily or permanently, but with no available care beds, too many remain in hospital for days or even weeks.

In September the NNUH recorded an average of 81 patients staying between two and three weeks and 138 patients staying longer than three weeks, for a total of 219 of the hospital’s 890 beds.

NNUH board papers explain: “Discharge pressures have been seen across the system. Further downstream a lack of capacity to meet demand is also leading to community beds being blocked.”

At yesterday's board meeting, the EDP asked the hospital’s chief operating officer Chris Cobb whether he hoped the numbers would return to normal by the new year.

He said: “I think it’s more than a hope. We have an expectation as a system that the plans we’re putting in place for winter and beyond are going to have some interventions which are going to help us reduce that number.”

The hospital launched a “Virtual Ward” earlier this year, which has seen more than 450 pass through, in which patients go home but are monitored and have 24/7 access to clinicians.

Although standardised “delayed discharge” data has not been published by the NHS since last February, related metrics reveal the story is similar at other hospitals.

According to board papers, at the Queen Elizabeth hospital in King’s Lynn this September, 419 medically fit patients spent a total of 2959 days waiting to be discharged, with 63 beds occupied by those who had been there more than three weeks.

At the West Suffolk in September, 198 patients were stuck in hospital for a week, 104 for two weeks and 63 for more than three weeks.

The latest James Paget board papers record a near-record 96 patients at the Gorleston hospital with a "right to discharge" up from 60 in May.

No available hospital beds means cancelled operations

Waiting lists are at record levels because of the pandemic, with 13,000 waiting more than a year for surgery, but with hospitals overflowing, too often planned operations are being cancelled at the last minute.

UPS courier Terry Dicker, 53, has osteoarthritis in both knees. As recently as last year he walked ten miles a day and went to the gym each morning before work, but since January he has been unable to work, or even walk.

“My right knee just seized up totally,” he explained, “but both my knees are the same - there’s no joint it’s just bone on bone.”

He has had steroid injections and a scraping operation but needs two new knees. However the progress of his treatment at the James Paget Hospital has been repeatedly delayed.

“I had an operation scheduled in July, but they phoned up the night before to put me off because there were no beds.

“It makes you quite ill. It’s hard because you tell your work that you’re going to have the op, then you have to tell them it hasn’t happened. And you worry whether they believe you.

“It’s hard on your mental health too. You get yourself psyched up to go in, then you’re let down and you just stay here. That happened twice.”

His right knee was operated on five weeks ago but not rebuilt, and he has seen no improvement yet. His left knee remains immobile.

The Dickers considered going private but cannot afford to.

“It’d be three grand for the op and fifteen grand for a new knee, and who has that kind of money?

“We’re already getting in more and more debt as it is - we’ve still got all the bills but not much money coming in.”

His wife Lynnie, 56, works part time at Tesco but the couple have used up their savings paying their bills while Terry has been off work, and are now borrowing money from Terry’s elderly mother to keep their heads above water.

She said: “It’s very worrying when you see him so down, I get so frightened. Some weeks he gets so depressed it’s terrible to see him in that state and I feel so helpless."

No available hospital beds also means ambulances can’t offload patients

At the Norfolk and Norwich on Sunday a patient waited in the back of an ambulance for nine hours.

The previous night 27 ambulances were seen queuing outside the A&E, unable to discharge patients.

A source told this newspaper that paramedics sitting in the queue could hear dispatchers asking repeatedly if any vehicle was available to attend Category One emergency calls.

Data reveals that ambulance handover delays into the hospital have gone up in line with delayed discharges out of the hospital.

The percentage of patients handed over within the target 15 minute window has plummeted from 60 percent in March to 34 per cent in September.

At the James Paget 464 ambulance handovers took more than 30 minutes in September, a fall from August but up from under 200 in January, February and March. The board papers explain: "Availability of beds and patient flow was not consistent due to poor flow out of the hospital."

And the QEH set a new record low for ambulance admission times, with just 64 per cent admitted, discharged or transferred within four hours. The NHS target is 95 percent.

A spokesperson for the NHS in Norfolk and Waveney said: “Across Norfolk and Waveney, health and care organisations are working collaboratively to help discharge patients safely from hospital as quickly as possible.

"Change is underway locally around the discharge to assess model which supports people to leave hospital, when safe and appropriate to do so, and continue their care and assessment out of hospital.

"They can then be assessed for their longer-term needs in the right place. This will help to prevent delayed transfers of care and allow more people to flow through acute hospital care systems if needed.”

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