NHS hospitals are at capacity. Ambulances are unable to handover patients to emergency departments, and tens of thousands of patients are waiting over 12 hours to be admitted to hospital because there are not enough beds or staff. Hidden behind this decline in NHS performance is an increasing proportion of patients facing delays leaving hospital because they are waiting for support to become available from health and social care services outside of hospital.
Most patients admitted to hospital return home, but some patients require additional care from health and social care services such as short-term rehabilitation in a community hospital, a place in a care home, or care at home. In an attempt to free up hospital capacity at the start of the pandemic, national guidance on patient discharge was changed so that all patients who are medically able to leave hospital, but still need care services, are first discharged to the most appropriate setting before an assessment of their more long-term support needs takes place. Even with these changes to the discharge process, an increasing number of patients face delays leaving hospital.
The NHS monitors delays to patient discharge – where patients are considered medically fit for discharge but remain in hospital. Between last December and August this year, the number of patients facing delays leaving hospital increased by 30%. Delays in transfer of care have been a growing issue for the NHS and social care for many years, but the scale of this issue has worsened, although the definition of delayed discharge is not directly comparable to the measure used before the pandemic.
Patients with hospital stays of three weeks or longer are known to have poorer health outcomes, are more vulnerable to infection, and can experience loss of mobility due to inactivity and bedrest. It could also have long-term consequences on their ability to maintain independence. While longer stays in hospital may be necessary, patients remaining in hospital due to delays highlight a key area for improvement of the quality of care provided by the NHS and wider social care system.
The rise in patients facing delays leaving hospital
Our analysis, based on a freedom of information request combined with publicly available data, shows that delayed discharges increased by 57% in the 12 months between April 2021 and April this year, from 8,039 to 12,589. We estimate that in April this year, one in six patients (15%) were in hospital due to delayed discharge (see data notes).
This increase occurred in patients whose initial hospital stay was longer than three weeks. Three out of 10 patients facing a delay had a length of stay longer than three weeks in April 2021. In April this year, these patients made up almost half (49%) of all patients facing delays – see chart below.
Flinders S and Scobie S (2022) “Hospitals at capacity: understanding delays in patient discharge?" QualityWatch: Nuffield Trust and Health Foundation.