As many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged.
So - if patients are ready to leave, what’s stopping them from reuniting with their families? The answer is - the persistent lack of social care
On average, 13,600 beds across NHS England are occupied every day by patients are medically fit to go home or to a care home. Since October, this figure has risen substantially, with 1 in 5 beds being filled with people who are able to go home. Health experts across the country believe that the cause of these delayed discharges are challenges within social care, including support in patients’ own homes or placements in a care home. As a result, over 35 Trusts in the UK have seen delayed discharges rise from 6% in April to 20% in October – and Liverpool university hospitals, which jumped from 10% to 23% within the same period. Miriam
The figures come as the NHS is gearing up for what is expected to be one of the toughest winters yet, with flu, Covid and record NHS staff vacancies putting pressure on the system. NHS England announced last month it was setting up system control centres or “war rooms” to cope. The Prime Minister and other policy bodies are soon to announce an intent to delay changes initiated by Boris Johnson. This would have put an £86,000 cap on the amount people have to pay for care. It is thought that delaying the policy would save the government £1bn in the first year, rising to £3bn if it were scrapped altogether.
The impact of delayed discharges on new patients has long been evident, with A&E departments heavily congested and ambulances queueing outside hospitals unable to transfer patients and get back on the road. Prof David Strain of the British Medical Association and the University of Exeter medical school said those unable to leave hospital because they are waiting for social care are a vulnerable population. “Very often they will have a physical disability, or they’ll have early or even profound dementia,” he said.
Strain added that moving such patients, for example to a ward of people awaiting discharge, can reignite delirium, meaning patients are instead kept in the same hospital bed.“That means that they’re often sat in acute medical wards, with patients coming in, very unwell … and I mean during Covid times, people who are literally coming in and dying in beds next to them,” said Strain. He also adds that the delays in discharge could range from about a week to a couple of months.
“It’s a major concern for both patients who are the victims of this, and also other patients that can’t get into hospital beds that need [them],” said Strain.
Prof Martin Green, the chief executive of Care England, said the personal impact on people was beyond measure.
“What we see are [that] late discharges often result in people having far more dependency than they would have done if they’d been discharged appropriately,” he said, adding that this can be traumatic for the individual themselves."
A major problem affecting social care is lack of funding, he said. “Some local authorities are paying [care workers] £6 an hour for 24-hour care, three meals a day, supporting people with loads of co-morbidities, having to do all the personal care stuff,” said Green. “How is that possible?”. In response, a Department of Health and Social Care spokesperson said: “We are investing £500m of extra funding to speed up the safe discharge of patients from hospital and recruit and retain more care workers to support people who no longer need to be in hospital.
The NHS is also creating the equivalent of 7,000 more beds this winter – enabling hospitals to treat patients more quickly, including by using remote monitoring to provide care at home or in the community. Only time will tell if this will stem the incoming winter crisis - and whether the NHS will be ready to rise to this challenge.