Community hospitals can play a vital role in providing support to patients recovering from hospital treatment to help them regain independence before going home. Delayed discharges from acute hospitals, where a patient is medically fit to leave hospital but isn’t discharged, have been highlighted as a key issue and area for improvement. There is little understanding, however, of delayed discharges from community hospitals and the capacity constraints they are under.
Despite there being no published data on the number of patients in community hospitals – which makes it difficult to understand the scale of delayed discharges – through a freedom of information request we have been able to estimate the proportion who are delayed in leaving community hospitals. In April this year, an average per day of one in five (1,703) patients in community hospitals were delayed. This is a 6-percentage point increase on the proportion delayed in June 2021 (the first month of complete data), indicating a worsening backlog across the system. At its peak in December last year, nearly a quarter (24%) of patients in community hospitals were there due to a delayed discharge. For reference, one in six (15%) patients were delayed in acute hospitals in the same month.
As part of their policy to improve hospital discharges, NHS England have sought to strengthen the availability of step-down care, helping patients who are medically fit to leave hospital but who require additional support to continue their recovery. In January this year, a non-recurring funding package was allocated to NHS services for discharging patients to step-down care in community hospitals, among other settings. When comparing the final three months of 2022 with the first three months of this year, we see an 8% increase in the average number of patients in community hospitals from 7,200 to 7,800 (which is 18% up on the June 2021 average of 6,415 patients).
We cannot ascertain whether this strengthened step-down policy has significantly helped to increase capacity and reduce delays, but the number of delayed discharges from community hospitals has steadily increased too, albeit more slowly. This indicates that capacity is constrained not only in acute hospitals but also in community hospitals, and that a lack of capacity across the whole system remains a significant problem.
NHS England are due to publish their Intermediate Care Framework later this year. It will be important that this recognises the need to manage capacity in community hospitals, as well as their integration with acute and adult social care services. There must also be long-term funding stability to allow for planning that can embed community hospitals as part of the discharge pathway. With the number of people delayed in acute hospitals remaining high, it is vital that bottlenecks are addressed rather than shifted elsewhere to the detriment of patients stuck in community beds.
Dodsworth E (2023) ‘Growing numbers of delayed discharges from community hospitals’. Chart of the week, Nuffield Trust.