Portsmouth hospital trust faces £13.9m deficit amid bed shortage

Portsmouth’s hospital trust is facing a significant bed shortage and a £13.9m financial deficit as high demand continues to put pressure on services.

High bed occupancy has been identified as a key issue, resulting in “delays in care and increased risk to patients and staff”.

The primary driver of this is so-called ‘bed-blocking’, which are delays in discharging patients after they have received treatment.

In August the chief executive Penny Emerit told the board that while the number of admissions had not gone up over the summer, the acuity - how ill patients were and how much care people needed- was “well above” that expected at that time of year. Occupied beds are running about eight per cent above what is expected for late summer in Portsmouth, equivalent to about 80 beds at QA. The higher bed occupancy and delay in discharging patients who are ready to leave was affecting the time it takes to see patients in accident and emergency (A&E).

The issue of the recurring challenges around bed occupancy, patient discharges and the health trust’s financial position came up at a board meeting of Portsmouth Hospitals University NHS Trust last week.

PHU modelling identified a peak unmitigated adult bed gap of 245 beds against 1,003 core beds for patients.

Twelve-hour waits are also above the trust’s planned trajectory, with 1,795 recorded in Portsmouth. This was down from 1,956 in July but remained slightly above plan.

The trust is also facing financial pressures. Its year-to-date position was a £13.9m deficit, compared with a planned £9.4m deficit – a variance of £4.5m.

The report said increased demand had prevented planned reductions in beds and staffing, contributing to the overspend.

Penny Emerit, chief executive of PHU, said while “the board will aim to address the root causes” no one organisation is “going to be able to solve the challenges”.

She said the pressures were a “consistent theme across the NHS”, but described the Hampshire and Isle of Wight system as an “outlier” in terms of occupancy and out-of-hospital services.

Christine Slaymaker CBE, associate director at PHU, said she had used the word “helpless” during a recent financial meeting because both trusts were “disadvantaged” by funding arrangements.

Ms Emerit said Portsmouth has predominantly unplanned patients, with 93 per cent of its bed base allocated to non-elective care.

This was because of “the community we serve” and a lack of “alternatives for people coming to hospital in the first place”.

She added: “the financial framework is set up in a way that effectively rewards the elective activity”, causing costs to “rise faster than the income”.

The underlying drivers of the deficit were identified as the cost of clinical staff for non-elective services and the need to staff escalation areas.

During the meeting, Nigel Chapman applauded Ms Emerit’s argument that “going along with the same old thing will bring about incremental improvement but not enough.”

Ms Emerit added: “We can see it, if we carry on doing what we’re doing, we are not going to address the scale of change that we need to.”