Delayed discharges show the NHS under strain

The problems caused by delayed discharges have been making headline news for a while now. Delayed discharges are not only a key indicator of how well hospitals are performing but also how well our health and care systems overall are working. The latest English data suggests a 23% rise in the number of days patients were delayed in December 2014, compared with the figures from 2013.

In September, the Royal Voluntary Service surveyed 401 older people across England, Scotland and Wales. Around a quarter of them who had been readmitted to hospital within three months of a previous admission felt that they had been discharged before they were ready to go home. 43% said they had needed a great deal or quite a lot of help when they left hospital, yet only 6 in 10 reported getting all they support they needed.

The latest survey, carried out in January this year, builds on that earlier work with the Royal Voluntary Service exploring the issue of support on discharge by looking at nurses' experiences of discharge in English hospitals.

There is a great deal of new information in this survey:

  • Almost 70% of respondents say they frequently have to delay discharging patients because there is no support in place for patients once they leave hospital
  • More than 35% of nurses have discharged patients aged over 75 before they felt they were ready to leave hospital in order to "free up a bed"
  • The vast majority of survey respondents believe that the three key factors causing delayed discharge are a lack of social care support and availability of home care; the need to wait for a final assessment before discharge and having to wait for non-acute care to become available elsewhere in the NHS

About 75% of nurses questioned think pressures on the NHS could be eased by working alongside charities and volunteers to ease the transfer of older people back home. We know that people who are helped by volunteer services value them immensely and there are indications that this kind of 'Home from Hospital' programme may also help reduce readmission rates, although there is more work to be done in this area.

Together with official information collected by NHS England and September's survey of patients' experiences this new survey of nurses in discharge settings provides evidence of a service under increasing strain.

David Buck  - The King's FundThanks to the work of the Royal Voluntary Service, we now have a richer picture than we have ever had before of older people's experiences of being in hospital and being discharged and how the work of volunteers can help both patients and hospital staff.

David Buck
Senior Fellow, Public Health and Inequalities at The King's Fund

twitter.com/davidjbuck

Delayed discharges

Across the UK delayed discharges are a key indicator of the performance of not only hospitals, but how our overall health and care systems are working.

In recent months, this has become a key concern for health and care systems across the country. The latest English data suggests a 23% rise in the number of patients being delayed comparing December 2014 with a year earlier.

Delayed discharges in England are measured and recorded on a monthly basis by NHS England. The latest data is for December 2014. In December 2013 there were overall 112,629 days delayed in terms of discharges, in December 2014 139,156, a rise of 23%.

Delayed discharge days Aug 10 - Dec 14

The most common reasons for delay in December 2014 were:

  • Awaiting residential or nursing home placement or availability - 24%,
  • Awaiting further non-acute NHS care - 20%
  • Awaiting completion of assessment - 19%

From December 2013 to December 2014, there has been a major rise in “awaiting care package in own home” as a source for delay, from 11% to 15% of all delayed discharges.

Analysis based on NHS England data available from england.nhs.uk

Posted by David Buck, The King's Fund at 09:00 Tuesday, 24 February 2015. 0 Comments

Labels: let's end going home alone, hospital, discharge

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