Night moves

Phil Hunt on the dramatic rise in hospital patients being moved during the night

Last year, over 20,000 patients were moved to a different place in a hospital during the night. This was reported by The Times after FOI requests revealed a worrying trend for moving people out of hours.

The scale of movements has apparently risen by nearly 20% in five years. Many hospitals reported that some patients had been moved four or five times in a night. Understandably, patient organisations are concerned. Mark Temple, Acute Care Fellow at the Royal College of Physicians (RCP) has stated that continuity is both central to quality of care and absolutely critical in terms of patient safety.

In some cases there will be good clinical reasons for moving a patient at night time. They may deteriorate or need a side room for infection control or a specific medical condition. They may come in for assessment and then need specialist care on a ward delivering a specific level of care. All of that can happen at night when the need arises. But patient moves bring clinical risks too. Length of stay has been shown to increase. It is disruptive of the clinician/patient relationship and a clear risk since multiple handovers could lead to the loss of patient data.

The growing number of patient movements at night suggests something is seriously amiss. The most likely reason is the sheer pressure on beds because of the rising tide of admissions. Deterioration in meeting the four hour A&E target is a barometer of a more general system problem. But movements at night-time can be an equally powerful signal of a system in real trouble.

Poor access issues in primary care has left people with little choice but to turn up at A&E, with hospitals filling up. The discharge of patients is becoming ever harder, with severe cutbacks in social services impacting on local authorities ability to provide community support. The result of such cumulative failure is that more and more old people are left without the support to let them stay at home.

The NHS should be focusing its energies on getting the system to work properly. Instead, it has been forced by the government to spend the past three years implementing a costly and unnecessary structural change. Meanwhile, enforced competition impedes service integration.

John Oldham, chair of the independent commission on whole person care has described current arrangements as creating a hydra-like array of accountability arrangements, yet with no clear strategic leadership. And he has shown how a Labour government could implement a new system providing health and social care services holistically, with the person rather than the institution at the centre. This would focus on helping people stay well, manage their illnesses and promote independence. It would also involve more specialist care at home and people much less subject to the trauma of unscheduled admissions.

It all fits neatly with the necessary redesign of our hospitals. In their excellent work on the Future Hospital model, the RCP proposed that specialist opinion and services be brought to the patient, who would be cared for throughout their stay by a generalist physician capable of maintaining continuity. This might not be popular with some consultants but it may well be the best approach to avoiding unnecessary night-time moves.

Lord Phil Hunt of Kings Heath is Shadow Health Minister in the House of Lords. He tweets @LordPhilofBrum

Published 20th March 2014