Audit chief says “radical” action needed on delayed hospital discharges

26 May 16

Radical action is needed to tackle delays in discharging older patients from hospital and stop the costs adding further strain to the financial sustainability of both the NHS and local government, the auditor general said today.

Hospital discharges are often held up because no care home place is immediately available. In an examination of the problem, the National Audit Office found the gross cost of keeping older patients in hospital when they no longer need acute clinical care is around £820m.

By contrast, shifting care to the community could result in additional annual costs of around £180m for other parts of the health and social care system, today’s Discharging older patients from hospital report said.

In addition to the financial cost, the analysis highlighted that longer stays in hospital can have a negative impact on older patients’ health as they quickly lose mobility and the ability to do everyday tasks.

Auditor general Amyas Morse said that the number of delayed transfers has been increasing at an alarming rate, with an increase in delayed transfer days of around one-third (270,000) over the past two years to the current figure of 1.15 million days.

However, this does not capture the true extent of older people who should not be in hospital, as only reflects when a patient is deemed ready for discharge, and not all cases when patients who are no longer in need of acute treatment. Based on evidence gathered by the NAO, the true figure for patients aged 65 and older who are no longer benefiting from acute care could be as high as 2.7 million days.

“While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there,” Morse said.

“Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.”

The report called on the Department of Health, NHS England and NHS Improvement to set out how they will break the trend of rising delays, as well as for improvements in information sharing between health and social care organisations.

Responding to the report, the Local Government Association's community wellbeing spokeswoman Izzi Seccombe said health and social care system was now facing a whole-year challenge not just seasonal winter pressures.

"Getting people out of hospital more quickly and back living at home will only work properly if councils get enough resource throughout the whole year to properly fund adequate provision of care services,” she added.

“Councils are absolutely committed to reducing the level of delayed transfers of care from the NHS and in the vast majority of areas are working with their local health partners to help reduce pressures on the NHS.”

Seccombe reiterated a LGA call for the £700m of extra funding earmarked for the Better Care Fund by the end of the decade to be brought forward.

A DoH spokesman said the government was giving local authorities access as much as to £3.5bn extra for adult social care by 2019/20, including through a social care precept on council tax.

“NICE has already published guidelines for better coordination between health and social care, and we are working closely with NHS England, NHS Improvement and local government to provide a wide-ranging package of support to improve quality and efficiency,” he added.

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