Birmingham’s largest hospital trust has blamed a bed-blocking crisis for its failure to hit A&E targets, which have put it in special measures.
Troubleshooters were called into Heart of England NHS Foundation Trust by overseeing body Monitor when it left scores of emergency patients untreated for more than four hours for the third winter in a row.
But the trust’s management, which run Heartlands, Good Hope and Solihull hospitals, has joined University Hospitals Birmingham Foundation NHS Trust in a wrangle against Birmingham City Council calling for £1.5million worth of fines because the local authority has failed to remove healthy patients blocking beds.
They believe delayed discharges – where mainly elderly patients are stuck for months in a hospital bed for no other reason than that they had nowhere to go or no care package – is putting a strain on their finances and ability to get patients seen quickly.
A Heart of England Trust spokeswoman said: “Delayed transfer of care is an issue for all hospitals as beds become occupied by those who no longer need to be in hospital.
“This consequently prevents new admissions getting to the right bed and a domino effect contributes towards delays in the system and accident and emergency.
“The trust and Birmingham City Council are working closely together to reach a mutual agreement that is best for patients, however if an outcome is not agreed then the trust can legally fine the council for those delayed discharges.”
Monitor chairman William Moyes said there had been a “significant breach” of four-hour A&E waiting time targets at Heart of England in January, giving the trust the worst risk rating of ‘Red’.
It comes as the city council was shamed by the Audit Commission with a ‘red flag’ for poor performance of failing to address an unacceptably high number of delayed hospital discharges.
A Comprehensive Area Assessment found that up to 150 patients were blocking beds in city hospitals. Five years ago, a pioneering agreement was drawn up in Birmingham which would see the NHS forego charging the city council £100 per day for each patient deemed to be unnecessarily blocking a bed because no residential care had been found for them.
This rule was set out in the national Community Care (Delayed Discharges) Act. Instead, NHS trusts agreed money would be better spend if the council invested the huge sums put aside for these fines into more social workers, care home places and services that would prevent bed-blocking.
But the Foundation trusts which run the lion’s share of hospitals in the city – Queen Elizabeth, in Edgbaston; Selly Oak; Good Hope, in Sutton Coldfield; and Heartlands, in Bordesley Green – appear to have suddenly lost faith in the system, withdrawing from the agreement with the city council and now demanding £1.5million in payments instead.
Peter Hay, chief social care officer at the council, hit back saying the hospitals have not made any notification of ending the agreement and are now trying to be “paid twice” in taxpayer’s money as the reins tighten on public sector funds. A Freedom of Information request by the Birmingham Post has revealed the extent of delayed discharge numbers and amounts invoiced.
The inquiry unveiled that University Hospitals Birmingham NHS Foundation Trust had raised invoices for £211,000 for April 2008 to March 2009 and £253,600 for April to October last year. Heart of England invoiced the council for £577,000 for the period of April to July last year.
A further £500,000 is believed to have also been invoiced since then. The total number of delayed discharges up to January 17 stood at 116 across the city.
Average bed-blocking figures over the winter have been well above 100 for the past few years, reaching 162 in February last year.
Last November and December, hospitals were forced to cope with averages of 146 and 135 patients respectively clogging up beds.
Mr Hay said: “The city council and the PCTs take the view that the local agreement on investment remains in place and are looking to resolve these issues. PCTs already pay hospitals for extended bad stays and we all want to make effective use of public money. It was a surprise when the invoices were put in. I have never had correspondence from these two trusts to say they were coming out of the agreement because I would have taken money out of the system to pay the fines.
“I accept that the agreement needs revising but it is still in place and I have spent money accordingly, some going to those hospitals.
They have taken the money and are now claiming twice. If they persist in claiming for the money, I will have to stop activity somewhere else in social services.”
Mr Hay added: “I think it is sad and regrettable to have a conversation over £1.5million in a city that spends £3.5billion on social care. We are able to do fantastic things when we work together but there are deep-seated parts of the system that do not want to do that.”
Gareth Duggan, spokesman for University Hospitals Birmingham NHS Foundation Trust, said: “We believe we have been invoicing Birmingham City Council appropriately. We are keen to engage with the city council and other key organisations in the broader health economy to ensure that patients are cared for in the most appropriate environment for their health needs.”
* CASE STUDY
Bridget ‘Bridie’ McCallion was only supposed to be in Selly Oak Hospital a few days, but she ended up never leaving.
Birmingham social services failed to sort out care needs for the 86-year-old grandmother, of Camp Hill, when nurses expected her to be discharged.
But as the issue drew on for weeks, Mrs McCallion then became infected with septicaemia, E-coli and Clostridium difficile (C.diff) in the hospital, run by University Hospital Birmingham Foundation Trust and was too ill to go home.
Daughter Catherine McCallion, of Mayfield Road, Tyseley, logged complaints with trust bosses and the Healthcare Commission and said she wishes her mother had never gone into hospital.
“My mother was supposed to be in hospital a few days with breathing problems but social services took so long to address her care needs at home that she then caught infections in hospital,” said Miss McCallion. “She should have come home before Christmas but ended up in hospital over New Year, Mother’s Day and her birthday.
‘‘She even got moved around five wards and some of those transfers were to make way for other patients and not for clinical reasons. The family felt that my mother lost her dignity while trapped in hospital for five months.
‘‘She gave up and died in April 2006. I blame social services and the hospital as they both had a part to play in her death in my eyes.”
In response to complaints, trust bosses wrote to the family apologising, stating that despite social workers agreeing to address care at home and lack of central heating for Mrs McCallion on December 17, 2005, nothing had been done by December 23 when the pensioner was due to be sent home.
In a letter to Mrs McCallion, a trust official said: “The social worker believed it was too early for her to commence the assessment, however this contradicts the trust’s communication to the council on December 21 that said your mother would be ready to leave hospital on December 22.”
“Birmingham City Council adults and communities directorate apologise for the dissatisfaction expressed about its services and share your family’s sadness that your mother never achieved her wish to return home from hospital
“On behalf of the directorate, Mr Gray apologised that his team were unable to have services ready to help your mother leave hospital during the times she was ready to use them.”
Mrs McCallion died in Selly Oak Hospital in April 2006 from mesentric infarction – a lack of blood to the abdomen.
Gareth Duggan, Trust spokesman, said: “The trust cannot comment publicly on the details of Mrs McCallion’s care, but has examined the issue in detail and at length through a series of letters and a meeting with the family.
“Miss McCallion raised a large number of concerns, and the trust takes such concerns very seriously, involving the chief executive in the subsequent review.”