Chart of the week: What’s happening to hospital discharges?

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. A delayed discharge is when a patient no longer requires hospital care but isn’t able to leave. Earlier this winter, hospital trusts in England were asked to work with local partners to cut delayed discharges by half by the end of January. Natasha Curry and Liz Fisher show how the situation has actually got worse since, and discuss the possible reasons why.

Data story

Published: 02/02/2022

Delayed discharges – whereby someone is deemed medically fit to leave hospital but is not actually discharged – have consequences that reverberate throughout health and care. As Omicron-fuelled hospital admissions began to climb in the run up to Christmas, NHSEI issued an edict to hospital trusts in England to work with local partners to cut delayed discharges by half by the end of January.

Since the start of December, however, we’ve seen a worsening of the situation. In the week ending 5 December, on average per day, there were 19,167 patients in English hospitals who met the criteria for leaving hospital. Of these, 55% (10,510) on average per day were not discharged, rising to 60% (12,819) in the week ending 23 January. Among patients who had been in hospital for 21 days or more, the situation is even more stark. Since the week ending 5 December, on average, nine in 10 of them who met the discharge criteria each day were not discharged.

This means that, overall, this winter so far over one in 10 available general and acute beds per day have been occupied by a patient who, according to the criteria being used, was fit to leave hospital but who was not discharged. Nearly half of such patients have had a stay longer than 21 days.

Delayed discharges are not a new phenomenon, but Covid is undoubtedly making things worse. High levels of staff sickness and self-isolation within the NHS, combined with severe capacity constraints in community and social care, are creating pressures. Councils are reporting long delays for new assessments, as providers of social care (in both home care and care homes) struggle to find enough staff to meet the needs of the clients they already have, let alone those newly discharged from hospital. Care homes still grappling with Covid outbreaks are also limited in their ability to take in new residents.

While the data cannot answer important questions about how the criteria for discharge is being implemented or the long-term outcomes of those discharged, what it does highlight is that health and social care are hugely interdependent. Until social care is put on a long-term sustainable footing with a long-term strategy for funding and workforce, attempts to tackle delayed discharges will be repeatedly thwarted.

Patients discharged and not discharged from hospital 02/02/2022

Chart

Note:  

The chart shows the rolling seven-day average of the number of patients no longer requiring hospital care. For example, the average on 5 December 2021 will be the average of the number of patients on that day and the preceding six days. Patients no longer requiring hospital care are defined according to the criteria to reside being deployed in hospitals as part of the Hospital Discharge and Community Support Policy and Operating Model.

Source:  

Nuffield Trust analysis of NHS England and Improvement's urgent and emergency care daily situation reports.

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