Health / Lengthy stays at hospital ‘growing’ as population gets older, NHS director says
Health board put under serious pressure over Easter weekend
THE NUMBER of patients with extended stays at the Gilbert Bain Hospital is “growing”, putting a further strain on the already stretched health service.
As many as 12 people had their scheduled surgeries postponed earlier this year because of a lack of available hospital beds.
And over the Easter weekend all of the Lerwick hospital’s contingency beds were also filled, leaving the NHS anxious to find spare beds outside the health service.
NHS Shetland said “delayed discharges” of patients was one of the reasons behind the lack of capacity at the hospital earlier this year.
Delayed discharges are classed as patients who are medically well enough to go home, but may not be able due to other factors.
These can include their mobility becoming worse while they are in hospital, or someone they are responsible for at home requiring specialist care.
With Shetland’s population growing older, and with the hospital set to undergo around £10 million worth of extensive repairs in early 2026, the NHS is having to come up with ways to deliver medical care away from the hospital.
But nursing and acute services director Kathleen Carolan said there are “no quick fixes” when it comes to delayed discharges.
In the first three months of 2025 between 13 and 14 patients were classified as delayed discharges every month at the Gilbert Bain Hospital, a freedom of information request from Shetland News found.
There were also more than 30 patients in the hospital staying for a week or longer every month in January, February and March, with as many as 36 in February.
During a period last month when the hospital was at full capacity, the average length of stay for a patient was 38 days.
Carolan said there had always been, and always would be, people that have longer stays at the hospital.
However she said the number of people having these longer stays in the Gilbert Bain Hospital is “growing”.
“We have a lot more older people in our community, so by definition there are going to be more people that are frail,” she told Shetland News.
“We have a growing number of people that require respite care too.
“There are no quick fixes here, people are getting older.”
Delayed discharges are “complex”, Carolan said, and required time to work through.
“They might be well enough to go home but other factors might need to be taken into account,” she said.
“Say you have someone with a urinary infection and they’re on antibiotics.
“They recover quite well and quite quickly, but their mobility has reduced while they’re in hospital, or they were already struggling, so they need extra time.
“It might be someone that has coped for a long time with caring responsibilities for someone else. There’s lots of things that can go into discharging a patient.”
Hospital still ‘really busy’ after tough period
The hospital “remains really busy”, Carolan admitted, but was back working to a “business as usual footing”.
However she said Easter weekend last month was a particularly stressful time for the health service.
“Before Easter we had several contingency beds open, and over Easter weekend all our contingency beds were full,” she said.
That had meant NHS Shetland had to think about where it could offer beds outside the hospital if there were any people requiring serious medical attention.
Carolan said, however, that they had “managed to get through Easter weekend” without the need to do that.
She said it does not take much “to go from green to red” at the hospital, with a relatively small staff team working day and night to keep Shetland well.
“Over Easter weekend all our contingency beds were full.” – Kathleen Carolan
In February, NHS Shetland was forced to take the rare step of issuing warnings about the pressure that the hospital and its staff were under, with beds at a premium.
And in March it then had to cancel up to 12 scheduled surgeries due to the continued strain.
Carolan said staff illness did not play a “particularly big part” in the disruption, but that a rise in flu and respiratory illnesses led to more admissions.
“There were a lot of people admitted with high acuity, major medical issues,” she said.
“We were getting to a point where we were full quickly.
“We decided it wouldn’t be safe to perform those [scheduled] surgeries because there were no beds for them to go to afterwards.”
The Gilbert Bain Hospital was a “real fine balancing act”, Carolan said.
As well as those needing to occupy beds for potentially weeks at a time, she said they had “people being admitted in an emergency” and “people coming to hospital because they have scheduled surgery”.
“We also have in the mix people coming in with serious acute illnesses,” she said.
“We have got to be able if someone has a heart attack, or a stroke, to have the right resources to care for them
“We have to be able to do everything, but we also have a hospital working at full capacity over a sustained period of time.
“It’s not what any of us would want.”
Delayed discharges ‘not good’ for patients
Less than five patients were classed as delayed discharges in September 2024, but that had risen to nine in November.
In December that figure was six, which then more than doubled to 14 in January 2025.
Carolan said they were keen to reduce the number of delayed discharges not just to free up hospital beds, but because it was “not good” for medically well patients to be stuck in a bed.
“We look after people’s medical needs, we keep them fed and keep them warm, but it’s not a stimulating environment,” she said.
“They often become more frail and even less able to get home. Our aim is always home first.
“For those staying in, there is not much for them to do.”
She said they were encouraging families to take patients like that out for the day, or even an hour, just to keep them moving.
“Being in hospital is not the same as being at home, so we want to try help people keep active,” Carolan said.
“We often find people aren’t as interested in life, they’re declining when they’re stuck in a bed.
“We just need someone to have a chat with them or play a board game.”
One way that the NHS is reducing the number of patients staying for a week or longer is through its new pathway ‘hospital at home’.
This sees the patient return home but continue to receive care from a consultant from the comfort of their own bed until the treatment has finished.
Carolan said that had helped to keep the NHS “out of real danger” when it came to the occupancy of the hospital.
While the programme was still a “test of change”, she added it has had a positive effect on patients’ care and helped to free up hospital space.
The nursing director thanked all of the NHS staff for “working so flexibly” and “all the extra time they have given” over a period of serious strain on services.
“Staff have postponed holidays to help keep the system safe,” she said.
“Lots of people have had really stressful periods of time on call too – that doesn’t go unnoticed.”
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