Hundreds of patients are taking up hospital beds across England every day despite being ready to leave, due to hold-ups in sorting transport, medicines and paperwork, or because they have nowhere to be discharged to, new analysis shows.
Disagreements between a patient or their family and medical staff, plus the need to install specialist equipment in a person's home, are among other reasons for delays. But the biggest obstacle to the speedy discharge of patients is lack of beds in other settings, such as care homes or community hospitals, which health chiefs have dubbed a "capacity crunch" that needs "appropriate funding".
It is the first time that figures have been published that break down the reasons for discharge delays.
They show that, among patients in England in June who had been in hospital at least 14 days since their arrival, an average of 1791 a day were unable to be discharged due to the lack of a bed in a residential or nursing home that was likely to be a permanent placement, while 1727 a day were waiting for a rehabilitation bed in a community hospital or a similar setting.
An average of 2033 patients a day were waiting for resources to assess and begin care at home, the highest number in any category, according to analysis by the PA news agency of NHS England data.
Some discharge delays involved issues within hospitals themselves, including hold-ups for a particular medical decision such as writing the discharge summary, which applied to an average of 390 patients per day last month. Other examples were waits for community equipment and adaptations to housing (an average of 234 patients per day), for a therapy decision to discharge (421 patients), for transport (98 patients), and for medicines to take home (44 patients).
NHS Urgent and Emergency Care Recovery Plan
An NHS spokesperson told the PA news agency: "Delayed discharges put considerable pressure on the NHS, which is why the health service has been working closely with colleagues in local authorities on a range of initiatives to send more patients home when they are medically fit to leave. The reasons for patients not being able to leave hospital when they are fit for discharge are often complex, and making more data available — as committed to in our urgent and emergency care recovery plan — is one way to help local health services plan with social care partners the alternative care that patients need, such as reablement support so they can safely return home, or a care home placement."
Delays in discharging patients can lead to knock-on effects in other parts of the healthcare system, such as fewer beds for people needing treatment and handover delays outside hospitals causing patients to wait inside ambulances, which was one of the biggest pressures on the NHS last winter. Two of the most complex reasons for delays listed in the new data are where there is a disagreement between a patient, their family, and the NHS about a plan to discharge; and when a patient is homeless or has no place to be discharged to.
Among people who had been in hospital at least 2 weeks and who were ready to leave but were not discharged, these reasons accounted for an average of 128 and 142 patients a day respectively.
Miriam Deakin, director of policy and strategy at NHS Providers, the membership organisation for NHS trusts in England, said: "Delayed discharge is caused by several factors including a capacity crunch of staff and beds in social care and community health services – both of which need appropriate funding. Investment in rehabilitation and intermediate care could also help more people stay independent in the community, reduce avoidable hospital admissions, and ensure that after a hospital stay, patients can return home or to a community setting in a timely way with appropriate support.
"The short-term national funding pots we've seen recently cannot offer sustainable solutions. A fully funded long-term workforce plan for social care, accompanied by debate about long term funding and reform, would put the sector on a sustainable footing."
