Alarming increase in the rate of delayed patient discharge
In the past twelve months, 20/20health has looked to reflect on the growing challenges facing the NHS, one area of focus has been the lengthy wait for admittance which is a common challenge to most NHS trusts. A contributing factor of this is delayed discharge, in which a patient remains in hospital despite being clinically ready to leave.
Recent NHS figures suggest that in an average almost 13,500 patients remained in hospital throughout December 2022, despite these patients fulfilling the discharge criteria. This is 30% more than the December 2021 average.
The impact this is having is profound, as it is increasing the pressure on hospital capacity. Studies have concluded that the main cause of delayed discharge is the difficulty in setting up suitable social care for patients waiting to be discharged.
Government figures suggest that around 24% of patients with delayed discharge are waiting for home care, 16% for a care home place and 24% for intermediate care. However, there has been some criticism of these statistics, with some commentators saying that the government is too ready to blame social care providers rather than addressing the issue, which is a potential lack of investment into the social care infrastructure in England and Wales.
The government has addressed this concern; the Health and Crae Act 2022 implemented the “discharge to assess” model (in which assessments are made post-discharge) and it was announced in September 2022 that there would be an additional £500 million of funding made available through the Adult Social Care Discharge Fund. The aim was for this to unblock up to 2,000 delayed discharge cases.
In January 2023, a further £200 million of funding was announced, which would pay for 4 weeks of care per patient, allowing for a further 2,500 people to be discharged from hospital.
Any funding to deal with this growing challenge is to be welcomed, and it is heartening to see the government acknowledge that this challenge exists. However, despite the pledges and the funding, there are still more than 10,000 patients in hospital who could otherwise be discharged. The impact this is having is profound, as patients with urgent medical needs are being denied an opportunity for treatment as their bed is being blocked due to infrastructure problems further down the healthcare cycle.
It is now imperative for think tanks, patient groups and healthcare professionals campaign for this growing challenge to be addressed.
Delayed discharge, or bed-blocking as it is commonly referred to in the media, is a major contributory factor in the series of challenges now facing the NHS. It can have a serious impact upon healthcare provision for those in desperate need of treatment. Unfortunately, it is not quite so simple as building more care homes or employing more staff to care for the vulnerable, as useful as they may be. Unfortunately, planning considerations and infrastructure concerns play their part.
It is important that policymakers consider one important consideration from the figures quoted; that 25% of patients are waiting for home care. Many of these patients are elderly; however, just because they are elderly does not mean that they should be forced into a care home against their will.
There is a real danger that patients could be forced permanently into a care home without informed consent, having profound impact upon the freedom of independence of some of the most vulnerable members of society. However, alternatives including improved rehabilitation could well mean frailer people could return to their own homes and have improved independence for longer.
Funding is always welcome, but it does not go far enough to actually deal with the root cause of the issue; the infrastructure surrounding adult health care in England and Wales.