Delayed discharges from hospital

Background

A huge challenge facing the NHS is that more patients are experiencing delayed discharges – whereby someone is deemed medically fit to leave hospital but is not yet discharged. Reversing this trend is a major system priority given rising waiting lists, overstretched A&E services, and the risks that unnecessary long stays in hospital pose to patients. 

Most people admitted to a hospital will be discharged home without any additional support, however some may require formal support in their own home, a short-term bed or a permanent bed in a care home. Discharging patients at the right time to the right location requires a well-coordinated system that can adequately meet the needs of patients. Delays arise when discharge processes in hospitals are slow and when capacity is constrained in out-of-hospital care. 

Patients with a longer length of stay in hospital (considered three weeks or more) tend to be in poorer health and may require more support upon discharge. It is therefore useful to understand how delayed discharges differ by length of stay and where demand is most pronounced. 

Responding to and reducing the number of delayed patients in acute hospitals has been a top priority for the government. The NHS delivery plan for urgent and emergency services recognises the need to improve discharge processes in hospitals and expand capacity in both intermediate care and social care. In January 2023, the government announced the allocation of £250 million to NHS services to increase capacity in step-down care providing reablement and other types of support. This is in addition to the Better Care Fund allocating £1.6 billion for 2023-25 to social care services to reduce delayed discharges. 

This indicator explores the number of patients experiencing delayed discharges and the reasons why they were delayed according to their length of stay. We then explore some of the bottlenecks for those in hospital for three weeks or more but who are delayed in hospital.

This indicator replaces a previous page on delayed transfers of care (DTOC) that is still accessible although no longer being updated. DTOC data is no longer being collected and, due to changes in the way this metric was measured, is not comparable with the discharge delays data presented on this page.  

Delayed discharges by length of stay

The total number of patients in acute hospitals who were ready to leave hospital but were delayed has increased by 43% from an average of 8,545 patients per day in June 2021 to 12,202 patients per day in September 2023. At its peak in January 2023, there were 14,710 patients delayed in hospital. 

The number of delayed patients who had been in hospital for 20 days or less has remained relatively constant since the dataset began at a daily average of 6,264. Changes in the total number of delayed patients are mainly attributed to increases in delayed patients who have been in hospital for up to 21 days or longer. Between June 2021 and January 2023, the number of delayed discharges for these long-length-of-stay patients increased two and half times from a daily average of 2,575 patients to 6,815 patients. From January to August 2023, however, there was an 18% fall in the average daily number of delayed discharges. Delayed discharges have since picked up again, increasing by 10% in September 2023. Growing numbers of delayed patients with a long length of stay would suggest squeezed capacity, particularly in formal care services. 

The impact of winter on the number of delayed patients is apparent, with peaks seen in January 2022 and 2023. The fall and rise of delayed discharges observed in late 2023 may also be indicative of winter pressures. Every winter sees an increase in A&E admissions and a reduction of staff due to sickness absence that can hinder effective discharge processes within hospitals.

Reasons for delay

Identifying the reason for delay helps us understand where failures in discharge occur and whether they differ by how long someone has been in hospital for. 

In October 2023, under a quarter of patients in hospital for seven days or more were delayed for reasons that could be attributed to the discharge process in hospital. These patients had been identified as medically fit for discharge, but needed further assessment, a discharge summary, or agreement on what further care they might need. 

The most common reason for delay for patients who had been in hospital for seven days or more was waiting for further support provided at home (24%). This type of care can be organised by both NHS community services and adult social care. An additional 19% were waiting for a short-term bed for support such as step-down care and reablement, and 19% were waiting for a permanent bed in a care or nursing home. 

The picture is slightly different for patients with a delayed discharge who had been in hospital for 21 days or more. Patients in hospital for three weeks or more tend to require more support upon discharge than those with a shorter length of stay. We see a higher proportion of delays attributed to services organised predominantly by social care. In October 2023, 21% of delays for longer stay patients were due to waiting for a short-term bed and 26% due to waiting for a permanent bed in a care home. Although fewer delays were attributed to the hospital (no plan or further assessment needed) compared with patients with a shorter length of stay, 18% (one in five) long-stay patients were still affected by delays because of discharge processes within hospital. 

Delays by discharge setting

Only looking at reasons for delayed discharges can mask the scale of the problem for different discharge settings. Here, we present the proportion of patients in hospital for 21+ days who are due to be discharged to a particular setting and are delayed. This gives us an indication of which discharge settings patients are struggling to access the most and therefore represent the tightest bottlenecks.  

Patients with a long stay in hospital who are due to be discharged to a permanent bed in a nursing or care home are the most delayed with a weekly average of 71% experiencing delays in September 2023. At its peak in June 2022, just shy of eight-in-ten (79%) patients were delayed in hospital waiting for a permanent care home bed. This discharge setting has also seen the biggest increase in demand; a 13-percentage-point increase since June 2021 (data not shown). Care homes were particularly affected by the Covid-19 pandemic which resulted in reduced care home capacity. Continued infection outbreaks along with staff shortages has meant care home occupancy remains below pre-pandemic rates.

In September 2023, a weekly average of 62% of patients due to be discharged to a short-term care bed were delayed, having increased only by 5 percentage points from June 2021. The proportion of long-stay patients requiring home care who were delayed has been consistently lower than other types of support. Since the beginning of 2023, the proportion of patients who were delayed waiting for home care has slowly fallen from an average of 51% in January 2023 to 46% delayed in September 2023. While this indicates that capacity may be slowly improving in home care services, the extent to which all three of these settings represent significant bottlenecks for being discharged out of hospital should not be underestimated. 

Pressures on social care services are well acknowledged. Growing demand, staff shortages in both domiciliary care and care homes, and under-investment have greatly reduced the capacity to provide care.