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A lack of NHS community services and social care provision is causing patients to get stuck in hospital beds when they are medically fit to be discharged.
As of December 2022, one in six patients (15%) – over 13,000 people – were in hospital due to delayed discharge.
Patients are stuck in hospital for increasingly long periods of time
Of these patients, a quarter (25%) were waiting for a care package at home; the same number (25%) were awaiting further assessment, a discharge summary, or agreement on what further care they need; 22% were waiting for a short-term bed, for example for rehabilitation; and 18% were waiting for a permanent bed in a care or nursing home.
The analysis, which was conducted by the Nuffield Trust, also found that the number of patients held up in hospital for three weeks or more when they were ready to leave has more than doubled, from an average of 2,350 patients in October 2020 to 6,390 in December 2022.
The length of time patients are delayed for has also increased significantly; the Nuffield Trust estimates that in December 2022, people in hospital for over three weeks were delayed for an additional 21 days on average – nine days more than in December 2021.
What effect does delayed discharge have on patients?
When patients remain in hospital despite being clinically ready to leave, it means there is no room for other patients to be treated, such as A&E patients and those waiting for elective care.
The NHS has been running close to capacity this winter, which not only puts more pressure on staff, but also has a significant impact on patient outcomes.
One analysis found that delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities.
The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and wellbeing.
Discharge delays were also found to be costly, accounting for up to 30.7% of total costs. They also prevented patients from getting the care they needed, causing elective operations to be cancelled and treatment to be delayed. This had repercussions for subsequent services, especially for elderly patients.
Data needs to be routinely published
Dr Sarah Scobie, Deputy Director of Research at the Nuffield Trust, says the NHS should ensure they are regularly publishing discharge data so progress can be monitored in this area.
She explains: “Month after month we see performance figures from the NHS showing how long people are waiting to get admitted to hospital or see a specialist. But there is much less routine data on the other side of the story: people who are ready to leave hospital but can’t get out.
“Our figures shed light on this issue, revealing a complex mix of problems including delayed hospital discharge processes, a lack of NHS community services and more well-known problems in social care.”