Policy update: Delayed discharge - what you need to know

Essential facts

Delays in discharging older people from hospital cost the NHS £820 million a year, according to a report from the National Audit Office (NAO).

Last year in acute hospitals, 1.15 million bed days were lost to delayed transfers of care, an increase of 31% since 2013. The NAO says rising demand for NHS services is compounded by reduced local authority spending on adult social care – down by 10% since 2009-10. 

Demography

The number of people in England aged 65 and over rose by 20% in the decade to 2014, compared with 8% for all age groups. By 2024, the figure is projected to rise by a further 20%. Between 2010 and 2014, older patients admitted as emergencies to hospital increased by 18%. Despite NHS England’s ambition to move care closer to people’s home, in 2015 older patients accounted for 62% of bed days in hospital. 

Impact on health

Longer hospital stays mean worse health outcomes for older people and increased care needs when they are discharged. Older patients in hospital can lose as much as 5% of muscle strength per day, and are also more likely than younger patients to acquire hospital infections. But the NAO report highlights the risks of discharging people before they are clinically ready. Premature discharge contributes to unplanned re-admission. 

Next steps

There has been some limited progress towards adopting principles of good practice in managing hospital discharge, and the NAO says care partners must draw on these existing initiatives. More accurate measures should be developed to capture the number of older patients experiencing delayed discharge because the true figure may be much higher than official data suggest. And wide variation in the proportion of older patients admitted from emergency services suggests some hospitals can improve their management of admissions.

Implications for nurses

With rising numbers of older people staying in hospital longer than necessary, nurses will have to focus more on supporting patients to stay mobile and perform daily activities such as washing and dressing. 

The NAO says unfilled vacancies in hospital and community teams, and a consequent reliance on agency staff, make it harder to maintain knowledge of services that can enable timely discharge. Practitioners should also be better trained in the law governing the sharing of information between health and social care, according to a guideline on transition published last year by the National Institute for Health and Care Excellence.

Expert comment

Peter Jones, Senior lecturer in adult nursing, London South Bank University

‘I suspect there are always going to be problems with transitions in care, especially when it is from one organisation to another, but this report suggests the number of delayed discharges is going up dramatically. 

Funding issues are central. There does seem to be some linkage between the falling off in funding for local authorities and the worsening of delayed discharges.

'In some ways, though, we know the solutions. There are good ideas out there. There are good practice examples dotted around the country and, if we could learn well from all the liaison and communication issues and get as efficient as possible, we could make a difference.’

Daniel Allen is a freelance health writer