Long-stay patients at Mater Dei Hospital

We read the article about the issue of acute beds at Mater Dei hospital being occupied by non-acute cases (The Sunday Times, April 13). Considering that the number of similar cases in St Luke's hospital was also about 60 to 80, it appears that the problem with so-called 'social cases' has migrated to the new hospital together with medical services. This is an unfortunate situation, though not an entirely unexpected one.

During the planning phases for migration of services, it was assumed that the availability of rehabilitation beds and intermediate care beds within Karin Grech hospital, together with certain provisos, would help prevent the annual winter overcrowding of wards (The Sunday Times, December 9, 2007). However, increasing the number of beds does not tackle the source of this problem but at best conceals it temporarily. A national review by the UK Audit Commission in 2003 on bed management found a strong correlation between the number of medical and rehabilitation beds a hospital has relative to its population and the number of emergency medical patients it admits. This means that, at least in the UK, hospitals tend to use any beds they have, regardless of population served. Therefore, increasing bed availability tends to be offset by increased admissions.

However, despite these findings and an average bed occupancy level of 95 per cent, the percentage of long-stay patients in the UK averages at about five per cent, which is lower than the 7.3 per cent (60/825 beds) to 9.6 per cent (80/825 beds) currently present at Mater Dei. This suggests that although the problem with occupied beds is generally unavoidable, it may be improved upon by introducing practices already established abroad.

One such practice is the formation of pertinent discharge planning teams for medical and surgical wards who focus on identifying, from admission, vulnerable patients whose discharge date may be delayed. This would allow the early establishment of a discharge plan together with the patients and their relatives. Such plans would include a discharge date established within 48 hours of admission and updated daily according to clinical change, early organising of social care packages and community therapy, and expedited referral to a geriatric unit, rehabilitation centre or residential home.