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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.
Thanks 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.
Senior Fellow, Public Health and Inequalities at The King's Fund
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%.
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
Help for older people this winter
Winter can be an especially hard time for older people. For someone with mobility problems, rain, snow and ice mean it's difficult to get out and about and this can lead to social isolation during the colder months. Feeling isolated and lonely can have a major impact on the physical and mental health of many older people. Keeping in touch with friends and family helps keep older people emotionally well but bad weather can put a stop to social activities.
Royal Voluntary Service volunteers can help people keep doing the things they want to do all year round, whatever the weather. We can provide transport to get out and about, help with shopping or with a trip to the hairdresser. Above all, we can provide a friendly face and much-needed companionship, perhaps over a cup of tea. The older people we work with tell us a visit from one of our volunteers can make their day. These are all little things, but together they can make a big difference to an older person's quality of life.
Former social worker Vanessa Bishop is one of our volunteer Good Neighbours. She's been visiting 90 year old Sheila Hunter for several months and the pair have become firm friends. Sheila was suffering from depression after a fall resulted in an eight-week hospital stay but with Vanessa's help she's starting to feel much more positive again.
"Vanessa's such a cheerful person and we have such fun together. She helps sort out my paperwork, she posts things for me, she takes my library books back and picks up my prescriptions. She's not a carer, she does what a friend or sister would do."
Vanessa hopes that when Sheila is fully recovered they'll be able to resume their trips out to the local garden centre and cafe, but in the meantime she's happy to provide companionship and a listening ear. She encourages Sheila to have hot drinks and warm food especially when it's cold outside, they do the crossword together, watch favourite shows on TV and they both love to talk.
"We describe ourselves as friends now because it's a very easy relationship... we have a lot in common and get on very well. It's just a lovely interlude in the week when I go and see her."
Vanessa would like to encourage other people with a bit of spare time to get involved too:
"It does make you feel more connected and useful. You're very directly involved in making a difference to someone else's life."
Take a look at our Get Ready for Winter tips on staying healthy and connected whatever the temperature as well as finding out what your local Royal Voluntary Service can offer. And if you have a few hours to spare, why not join us as a volunteer? Be one of our 35,000 volunteers who are committed to helping older people live independent and fulfilling lives. We have opportunities across the UK and would love to hear from you.
This blog was originally published on the Met Office website.