The challenge of discharging patients who are fit to leave hospital in a timely manner has been widely documented. Throughout last winter, official statistics highlighted the startlingly high numbers of people who remained in hospital despite being well enough to leave.
Over the past six months, an average of 13,531 patients remained in hospital longer than required each month – an increase of more than 1,000 on the six months before.
The factors contributing to delays are multi-faceted. Solving them will require a shift in the way services are delivered, as well as cross-organisational collaboration. Short-term national funding pots, as we have seen in recent months, have not gone far enough to meaningfully address the problem.
Delayed discharges are causing severe pressures on urgent and emergency care pathways and lead to many thousands of people staying in hospital unnecessarily often to the detriment of their health, mental and emotional wellbeing and independence. It is time to think seriously about what needs to be done, both nationally and locally, in the medium to long term.
What is needed to sustainably solve the issue of delayed discharges?
Greater investment in public health, prevention, social care and community services
- The high levels of delayed discharge over the past six months can, in part, be attributed to the acuity and complexity of need for health and care services across the system. Evidence shows that the general health of the population has deteriorated over the past decade, with the amount of time people live with poor health increasing in recent years.
This means the health system is in contact with increasing numbers of people with complex needs, some of which require ongoing care post-discharge following time spent in hospital. This is putting unsustainable pressure on system partners, including local authorities, to urgently locate and deliver packages of care. It would be preferable for more people to be supported to stay healthy and well in the community to prevent admission in the first place. To facilitate this, greater investment is needed in public health, prevention, social care and community services, including a significant increase to the public health grant to meet growing demand and inflationary pressures.
Greater prioritisation of the role of intermediate care
- Although the use of early intervention and preventative services, including 'step up' care would help reduce demand for acute health services, for many people hospital will always be the right option.
On these occasions, an enhanced approach to intermediate care – in which an individual receives high-quality rehabilitation and reablement services – would support timely discharge and reduce the risk of readmission.
However, the current provision of intermediate care varies across the country, resulting in a postcode lottery for patients. We really welcome NHS England's plans for an intermediate care strategy because it is vital that we ensure there is good provision everywhere in the country. Adequate resourcing is desperately needed to ensure trusts and system partners can reduce variation in what is provided, and deliver the new national target for patients to receive step down care within 24 hours of being ready to leave hospital.
A fully funded workforce plan for health and social care
- Trust leaders cite staff shortages across the health and social care sector as the key limiting factor impacting the flow of patients through the system, including delaying discharges. It is therefore vital that both the NHS and the social care sector have a costed and fully funded workforce plan to ensure there will be the right number and mix of staff to support the ambitions outlined above.
Without this, there will not be the capacity to provide early intervention and preventative services, nor will there be the appropriate mix of health and care staff to provide high-quality rehabilitation for patients post-discharge.
We look forward to seeing the NHS long-term workforce plan and hope it will take into account the importance of all health and care professionals that help keep people well – including community-based roles such as physiotherapists and community nurses.
Tackling the problem of delayed discharges is difficult, but doing nothing is not an option. Trusts and system partners are acutely aware of the real-life consequences of allowing the current rate of delayed discharges to persist for both patients and staff.
Integrated care systems bring the potential to embed collaboration as a means of addressing these longstanding challenges. This is already being demonstrated across the country.
However, system partners cannot weather this storm alone. There must also be the national focus, willingness and financial support to think bravely about what's needed in the medium to long term. Without a decisive shift towards prevention and admission avoidance, systems will never be able to fully address delayed discharges.
This opinion piece was first published by HSJ.
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