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Thousands of hospital patients must be discharged early from hotels or their own homes to free up beds for Covid-19 patients in need of life-or-death care, The Guardian discovered.
Heads of hospitals in England intend to start discharging patients early on a scale never seen before, as an emergency measure to create “additional emergency contingency capacity” and halt the collapse of parts of the NHS, high-level sources said.
Documents seen by The Guardian also revealed that the NHS is asking nursing homes to start accepting Covid patients directly from hospitals and without a recent negative test, provided they have been in isolation for 14 days and have shown no new symptoms. .
Under the “home and hotel” scheme, patients discharged early from a hotel will receive help from voluntary organizations such as St John Ambulance and the British Red Cross, armed forces medical personnel and any available NHS personnel.
The London Hotel Group (LHG) has started taking homeless Covid-positive patients from King’s College Hospital in South London and is caring for them at its Best Western-branded hotel in nearby Croydon. It is in talks with 20 other NHS trusts and says it could provide 5,000 beds.
Families are expected to play a key role in following up and caring for loved ones who are sent home days or weeks before they would otherwise have left the hospital, with the support of healthcare professionals whenever possible.
The plans come amid growing concern that hospitals will soon be overwhelmed and that the crisis may not peak for several weeks. More than 35,000 Covid patients are in UK hospitals, and that number increased by 6,213 in the last week alone.
NHS leaders fear that the new variant of Covid, which has raised infection rates in London and the southeast and east of England, is leaving many hospitals scrambling to cope and will soon follow suit in the southwest and northwest.
Record levels of sick leave from the health service and its central role in the government’s mass vaccination campaign led NHS sources to warn that few employees will have time to provide meaningful care in private homes or hotels once patients are discharged.
But they said patients won’t be asked to leave the hospital early if they’re still at medical risk, so they should mostly need mild care. “This is for patients who do not need to be in a hospital bed, but need to be in a protected environment,” an official said.
NHS England, as well as heads of hospitals under the most extreme pressure, are having detailed discussions about implementing the “home and hotel” option for what a senior NHS source said would involve “thousands” of patients. . It is part of their efforts to create “extra emergency contingency capacity” once other options have been exhausted, such as doubling or tripling critical care capacity and utilizing Nightingale emergency field hospitals, the sources said.
LHG said its hotels could provide beds for at least 5,000 patients facing early discharge, including 1,500 in London. LHG CEO Meher Nawab said: “We will look to implement this solution in our hotels to provide hospitals with a lifeline at this critical time.”
An LHG spokesperson added: “The group of patients the NHS is trying to accommodate at this stage is recovering or is recovering from Covid and is medically fit for discharge and therefore does not require specialized medical supervision or specialized care. but still can’t go home. This frees up space and capacity for NHS beds and is relatively easy for hotels to install. “
But the plan has sparked controversy, with patient groups expressing discomfort at its impact. Lucy Watson, President of the Patients Association, said: “This is a desperate situation, in which the NHS often does not have good options available. Discharging patients from hospital is likely to be one of the few options open to the NHS to manage the magnitude of the current need.
“However, early discharge can often cause problems that result in patient harm and the need for readmission. The care of volunteers in hotels is not an adequate substitute for adequate hospital care. But at a time when hospitals are overwhelmed by critically ill patients and struggling to prevent large-scale loss of life, they will clearly be making desperate decisions. “
Dr. Charlotte Augst, Executive Director of the umbrella group of health charities National Voices, said: “We have questions about where the health and care staff who will care for these people will come from and how any deterioration will be addressed given the long waits. for 111 or 999 services.
“In our opinion, this proposal is indicative of the unpleasant decisions that NHS leaders are now forced to make due to the immense pressures placed on the system by this latest blockade that comes once again too late to protect the NHS’s ability. of providing universal, high-quality services for all. . “
Jeremy Hunt, the former health secretary who now chairs the Commons health select committee, warned Tuesday that the NHS is facing a “triple whammy” of pressures that could leave it dangerously exposed this winter and mean that further pressure may not get through February.
Chris Hopson, executive director of NHS Providers, said the trusts would expand capacity, but “will also work closely with community services and social care partners to maximize discharge of medically eligible patients.”
Meanwhile, the NHS is asking nursing homes to start accepting Covid patients directly from hospitals and without a recent Covid test, The Guardian has learned.
The policy had been to send Covid patients to designated “hot” nursing homes where the spread of the infection could be limited and prevent a repeat of last spring’s epidemic in nursing homes, which was in part driven by those discharge from hospital. But the goal of establishing 500 homes of this type has not been met, leaving only 2,533 beds available.
An NHS document sent to some care providers says: “We are now advising that for some within this group, it will be appropriate for them to move directly into a nursing home from the hospital… because we now know that they do not pose a risk of infection for other residents in a nursing home “.
If doctors assess that a patient has no new symptoms or exposure to Covid and has completed their period of isolation, they can be discharged directly to a nursing home without further testing for Covid in the 48 hours prior to discharge, it adds.
The plan has raised concerns among care operators who want assurances that anyone who leaves the hospital 14 days after a positive test still cannot transmit the virus.
“We’ve said that we need to see strong clinical evidence,” said Nadra Ahmed, executive president of the National Association for Care, which represents independent care operators. “We need to have absolute confidence if someone leaves the hospital after being positive for Covid that they are no longer infectious.”
Professor Martin Green, CEO of Care England, which represents private care providers, said: “The key is that nursing homes must decide and hospitals must not put undue pressure on nursing homes.”
The Department of Health and Social Assistance has been contacted for comment.
