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 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 1,791 a day were unable to be discharged due the lack of a bed in a residential or nursing home that was likely to be a permanent placement, while 1,727 a day were waiting for a rehabilitation bed in a community hospital or a similar setting.
An average of 2,033 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 involve 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 are 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).
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 the 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 two 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.
Delayed discharge is caused by several factors including a capacity crunch of staff and beds in social care and community health services— Miriam Deakin, NHS Providers
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.
“We hope this data published by NHS England shines a light on these issues and encourages efforts – nationally and locally – to address them.”
Hospitals in south-east England account for around one in five patients in each of the main categories, a higher proportion than any other region, PA analysis shows.
This includes 437 (22 per cent) of the 2,033 daily average of people waiting for resources to start care at home, 355 (20 per cent) of the 1,791 waiting for a bed in a residential or nursing home, and 330 (19 per cent) of the 1,727 waiting for a rehabilitation bed in a community hospital.
University Hospitals Sussex was the NHS trust with the highest average of delayed discharges due to a wait for resources to begin care at home, at 99 patients per day, ahead of Manchester University (70) and Leeds Teaching Hospitals (66).
It also had the highest average for delays due to waits for a bed in a community hospital (85 patients per day), ahead of Norfolk & Norwich University Hospitals (56) and University Hospitals of Leicester (55).
Manchester University NHS trust recorded the highest average due to waits for a bed in a residential or nursing home (81 patients per day), followed by Leeds Teaching Hospitals and Liverpool University Hospitals (both 80 per day).
We are investing a record £1.6 billion to support timely and safe discharge from hospital— Department of Health and Social Care
Overall, an average of 12,334 hospital beds in England per day last month were occupied by people ready to be discharged – down from 12,597 in May and 12,760 in April.
The equivalent figure for June 2022 was 11,590.
A Department of Health and Social Care spokesperson said: “We are working to ensure patients leave the hospital as soon as they are medically fit, and the number of patients each day who are ready to be discharged but still in hospital has reduced by 2,200 in England since January.
“We are investing a record £1.6bn to support timely and safe discharge from hospital. This is on top of £700 million to ease hospital pressures over last winter and buy thousands of extra care packages and beds.”
Matthew Reed, chief executive of end-of-life charity Marie Curie, said: “The simple but terrible truth for people with a terminal illness is delays to discharge means they can die in hospital when they neither want or need to be there. That is the worst possible outcome for them, the people they love and for NHS resources.
“The fact that the obstacles to timely discharge include a lack of beds and equipment in the community should be a wake-up call to the government to ensure dying people get the care they need, and to ready the NHS for the extra stress the country’s ageing population will place on it.”
