Government criticised for showing 'lack of ambition' as discharge delays cost NHS £800m

The Government is facing criticism after a report by the Public Accounts Committee (PAC) urged it to address the scale and cost of delays in discharging older people from hospital.

The Committee’s report urges new measures to tackle the problem, which is bad for patients' health and the financial stability of both the NHS and local government.

The report details a 'poor understanding' of the scale of the current problems faced when discharging patients from hospitals, with figures significantly under-estimating the range of delays and the number of older people affected.

The number of unnecessary delays are bad for the financial sustainability of the NHS and local government and the National Audit Office (NAO) has estimated a gross cost of around £800m per year for the NHS, with older patients often delayed in hospital when they no longer need to be there.

'Delays damage patient health and the public purse'

Chair of the Public Accounts Committee and MP Meg Hillier commented: "Studies indicate older people can lose five per cent of muscle strength per day of treatment in a hospital bed.

“Delayed discharge is damaging the health of patients and that of the public purse. While there have been improvements, the Department of Health and NHS bodies are still failing to properly address the root causes of this problem.

“Blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out when the Government has clear indicators of what works and the power to drive change.

“Best practice can be as simple as planning a patient’s discharge early in their hospital stay, or conducting shared patient assessments between health and social care providers. NHS Improvement should move faster to ensure such approaches are widely adopted.

“Evidence also shows that discharge performance is best where local health and social care organisations work together effectively, sometimes in fully integrated systems. The Government must learn from this and push the pace of integration where evidence supports doing so.”

Unacceptable local variations in performance

The report revealed ‘unacceptable variation’ in local performance on discharging such patients, and found that while good discharge practice is well understood, ‘implementation is patchy across local areas’.

The PAC report further identified a ‘significant barrier’ to improving performance and recognised the ‘fragility of the adult social care provider market’ was exacerbating discharge difficulties. The report concluded: ‘Patients and the NHS have a right to expect better’.

While the report highlighted improvements that had been made, the Committee recognised that the Department for Health and NHS England relied on local circumstance for not seeing improvements in services.

Ms Hillier continued: “This Committee is vividly aware of the financial pressures facing the NHS but does not accept maintaining the status quo is an adequate ambition – particularly when the consequence is additional costs running to hundreds of millions of pounds.

“Improving discharge performance is critical to the well-being of patients and the public finances and we challenge the Government to deliver the benefits we would expect from a greater hands-on commitment to this goal."

Widening gap between availability and demand for adult social care

The report highlighted evidence supplied by NHS England which reported that pressure on local authority funding ‘would see a widening gap between the availability of, and the demand for, adult social care over the next few years’ and that it would ‘prevent significant progress being made in reducing delays over the next five years’.

The PAC report also acknowledged the pressure on funding, however did not accept that was a sufficient reason for a lack of further improvements and urged a greater commitment to implement changes, before concluding ‘NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement’.

Professor Gillian Leng, deputy chief executive and director of health and social care at the National Institute for Health and Care Excellence (NICE), said: “It’s clear that we need to improve the way that patients are discharged from hospital, especially when they no longer need the same level of care. Whilst we understand the pressures facing our health and social care system, our guidance aims to improve the situation that some patients, particularly elderly patients, are finding themselves in.

“Our social care guidance, ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’, makes recommendations that will help make the move from hospital to home as painless as possible for patients. For example, we recommend that one person, either from the hospital or community-based team should be made responsible for a patient’s discharge from hospital.

“NICE also recommends offering older patients early supported discharge – this is where a patient can be discharged from hospital early to receive rehabilitation support at home.

“It’s important that our guidance and recommendations are implemented and embedded into the culture across health and social care. The message is clear; the focus should always be on the patient.”

The PAC has called for NHS England to co-ordinate work to help understand the cost to hospitals and the public of delayed discharges and caring for people in the community.

Circumstances of hospital discharge vital for long-term recovery

In addition, the Committee said the Department of Health, NHS England and NHS Improvement must take steps to understand the reasons for local variations in discharge delays, as well as recommending measures to improve the sharing of good practice and information.

Director of Age UK, Caroline Abrahams said: “How and when someone is discharged from hospital, and the support they receive afterwards is vital when it comes to their long-term recovery and quality of life.

“Cuts to council and community health budgets mean more and more older people who need support to stay fit and well at home aren’t getting it. This makes it more likely that frail older people become ill and need to go into hospital, and less likely that they can be discharged in a timely way once medically fit to leave.

“Keeping someone in hospital when they don’t need to be there is an awful situation and one that represents a staggering waste of public funds that also hurts vulnerable older people and their families. It is why we believe the Government should urgently look again at the funding being provided for these kinds of services, acknowledge the need for substantially more investment, and take action to plug the all too obvious funding gaps.”

A Department of Health spokesman revealed that an extra £3.5bn allocated for adult social care by 2019-20 should help more patients to leave hospital on time. He said: “Elderly patients should never be forced to stay in hospital unnecessarily - we are determined to make health and social care more integrated.”