Difficulties finding home care for patients on discharge mean that many are forced to remain in hospital
“Our members accept more progress on reducing delayed discharge is needed, but the collapse of the domiciliary care market as the cost of living increases beyond wages is making it impossible for them to make progress." Rory Deighton, acute lead, NHS Confederation
The number of patients who are stuck in hospital, even though they are well enough to be discharged, has continued to increase in the past few months, HSJ has reported.
Statistics for April show that an average of 12,589 patients per day in NHS hospitals in England – 13% of all occupied beds – did not meet the “criteria to reside”. At 31 trusts, the proportion was 20% or more. The reason for the delayed discharge is a lack of care plan for those patients.
NHS England has told local leaders to prioritise the reduction of delayed discharges an operational priority. The occupation of beds by patients who are well enough to leave hospital is partly responsible for the long waits in emergency care, as ward beds are taking longer to become available to accident and emergency patients.
Trusts are finding it impossible to reduce the numbers, NHS Confederation has warned. Rory Deighton, acute lead at NHS Confederation, said targets to reduce delayed discharges “will not be met” unless the government “invests in domiciliary care wages,” amid high numbers of vacancies in the social care sector.
He added: “Our members accept more progress on reducing delayed discharge is needed, but the collapse of the domiciliary care market as the cost of living increases beyond wages is making it impossible for them to make progress. Care providers are running to stand still as they continue to lose staff to better paid roles in retail and hospitality.”
A national discharge fund, which has provided almost £3bn over the past two years to fund free care for people leaving hospital, ended in April. No ringfenced funding for post-discharge support has been made available in 2022-23.
Some trusts are working to remedy the problem. Stockport Foundation Trust, where the proportion of beds occupied by patients well enough to be discharged is 31%, said it has opened a new trauma and orthopaedic ward. The trust is also planning to invest £30m in emergency and urgent care facilities, which it said should help improve patient flow. Other trusts, such as the Royal United Hospitals Bath Foundation Trust, and Yeovil District Hospital and Somerset FT, said they were collaborating with local authorities to address the issue.
In December, NHS England and the Department of Health and Social Care set up a “national discharge taskforce”, led by Sarah-Jane Marsh, chief executive of Birmingham Women’s and Children’s Hospital Foundation Trust, to share best practice to help the patients waiting longest in hospital. An NHS England spokeswoman said that the taskforce was working closely with integrated care systems (ICSs) to develop best practice, which included actions such as minimising delays in transfer from acute hospitals to follow-up care, reducing long stays in community beds and making sure social care services were available at the right time.
David Maguire, senior analyst at The King’s Fund, said the government should form a long-term social care workforce plan and for integrated care systems to smooth local disputes about social care funding. The co-operation facilitated by ICSs should, he said, “result in “significant progress” on delayed discharge.
The plight of well patients taking up hospital beds when they are well enough to go home is a continuing scandal. It causes distress both to the patients themselves and to emergency patients unable to access a bed they desperately need. Research by the Homecare Association shows that there is a dire shortage of homecare workers to meet growing demand.
Integrated care systems, which come into force in July, will go some way to addressing the problem by making sure that local authorities and the NHS work together rather than in opposition. The shortage of homecare workers, however, can only be solved by much greater investment in the sector and a willingness to cast the recruitment net more widely.