There has been substantial pressure on hospital beds this winter, with people experiencing lengthy waits to be admitted and ambulances facing difficulties handing patients to emergency departments. Contributing to this is the large number of people remaining in hospital despite being clinically ready to leave – referred to as a ‘delayed discharge’.
In December 2022, an average of 13,440 patients a day remained in hospital despite no longer meeting the criteria to stay. This is 30% more than the daily average for December 2021.
As well as increasing pressures on hospital capacity, delayed discharges can lead to poorer outcomes for people and contribute to a loss of independence (PDF).
Difficulties in setting up social care for people leaving hospital is one factor contributing to delayed discharges. This Insight looks at what the Government is doing to reduce the delays, focusing particularly on adult social care.
Number of delayed discharges
Since December 2021 NHS England has published data on patients in England remaining in hospital who no longer meet the criteria to stay.
The latest data shows that in December 2022, an average of 13,440 patients per day remained in hospital despite being ready to leave. This is 30% higher than the December 2021 daily average of 9,150.
Although the current NHS England data does not attribute responsibility for discharge delays, the Government suggests around 24% of patients with delayed discharges are waiting for home care (PDF), 16% are awaiting a care home place and 24% are waiting for intermediate care.
In its January 2023 delivery plan for recovering urgent and emergency care (PDF), the Government said increased capacity in intermediate care and social care (particularly homecare) was needed to improve discharge. It said this “requires sustained long-term investment, in particular in the social care workforce given the scale of vacancies”.
Stakeholders have, however, raised concerns about a narrative blaming social care “for all delays to discharge, despite [it] having never been the primary reason.”
Further information the social care workforce and funding for adult social care more broadly is available in separate Library briefings.
Delays in previous years
Before 2021, NHS England published the data collection ‘delayed transfers of care’. It was paused in March 2020 because of the Covid pandemic and has not yet been reinstated.
As the chart below shows, following a downward trend from March 2017 to mid-2019, the number of delayed discharges began to rise in late 2019 and early 2020 – especially for delays when the need for social care was a factor.
“Discharge to assess”
During the Covid-19 pandemic, there were attempts to speed up hospital discharge by temporarily relaxing requirements for care assessments to be completed before a person left hospital. This allowed for national implementation of the “discharge to assess” model, where assessments are undertaken post-discharge.
These changes were made permanent under section 91 of the Health and Care Act 2022, which came into force on 1 July 2022.
During the pandemic, extra funding was provided to cover the follow-on care costs of people discharged under the new model. This ended at the end of March 2022.
Adult social care discharge funding
In its September 2022 Plan for Patients, the Government announced a £500 million Adult Social Care Discharge Fund, “to support discharge from hospital into the community and bolster the social care workforce, to free up beds for patients who need them.” The funding came from underspends and efficiencies from NHS and Department for Health and Social Care budgets.
£300 million will be given to integrated care boards (ICBs) to improve bed capacity and £200 million will go to local authorities. The funding will then be pooled into the local Better Care Fund.
60% of the funding was allocated in December 2022, with a second tranche in January 2023.
The Secretary of State for Health and Social Care, Steve Barclay, said the funding will “unblock an estimated 1,000 to 2,000 delayed discharge cases.”
The Nuffield Trust, a health think tank, suggested that while a focus on reducing delayed discharges was understandable, it is “unlikely that a relatively small temporary fund will magically fix the myriad factors underlying the problem.”
Concerns were also raised about how long it took the funding to reach ICBs and local authorities.
Funding to block-buy care home beds
On 9 January 2023, the Government announced £200 million – on top of the Adult Social Care Discharge Fund –for the NHS to immediately block-book care home beds to speed up hospital discharge.
The funding will pay for up to four weeks of care per patient until the end of March 2023. Steve Barclay said this will allow for 2,500 people to be discharged from hospitals.
However, the Health Foundation has noted the vast majority of people in hospital do not need a care home placement. It’s also been suggested the policy risks people spending longer than necessary in care homes unless certain conditions on how the process works are in place.
The Association of Directors of Adult Social Services (ADASS) has also raised the risk of people making permanent moves to care homes without informed consent as a result of the scheme.
In a joint letter to the Health Secretary in January 2023, ADASS, the Local Government Association and Solace, listed actions that could be taken to address pressures in hospitals, in addition to the steps taken by the Government.
Funding for hospital discharge in 2023/24
In the 2022 Autumn Statement, the Government announced £600 million of new grant funding in 2023/24 and £1 billion in 2024/25 to help get people out of hospital and into care settings.
Local authorities will receive £300 million of this funding in 2023/24, which will be pooled as part of the Better Care Fund. Funding allocations were published in December 2022.
Further information on this funding and Government efforts to ‘scale up’ social care services more generally is provided in the Government’s Delivery plan for recovering urgent and emergency care, published at the end of January 2023 (pp29-31).
About the author: David Foster is a researcher at the House of Commons Library, specialising in adult social care.
Photo by Andrew Norris on Adobe Stock