Workforce capacity issues in health and social care organisations are making it difficult to discharge older patients from hospital effectively, a report has warned.
Across the health and social care system, providers and commissioners said that staff recruitment and retention were a significant cause of delays, according to the National Audit Office report.
“The number of delayed transfers has been increasing at an alarming rate”
It warned that vacancy rates for nursing and home care staff were up to 14-15% in some regions, and fewer than half of hospitals felt they had sufficient staff trained in the care of older patients.
Efforts to speed up discharge was also being inhibited by health and social care organisations not sharing patient information effectively, despite a statutory duty to do so.
While hospitals were financially incentivised to reduce discharge delays, there was nothing similar to encourage community providers and councils to speed up receipt of patients, added the report titled Discharging older patients from hospital (see attached PDF below).
As a result, the NAO said many older people were still being kept in hospital without a need for acute clinical care, hampering their independence and costing around £820m a year.
An ageing population and more people being admitted to hospital meant there needed to be a “step change in performance to resolve the problem” of delayed discharge across the country, it warned.
The spending watchdog described the health and social care system’s current management of discharging older patients as “not representing value for money”.
Longer hospital stays can not only have a negative impact on older patients’ health as they quickly lose mobility, but keeping them in hospital longer than necessary is also an “additional and avoidable pressure” on the financial sustainability of the NHS and local government, it said.
“The NHS needs to be much more ambitious about fixing this now”
In addition, the NAO report claimed that official data on delayed transfers of care substantially under-estimated the range of delays that patients experienced.
Over the past two years, the data suggested there has been an increase of 270,000 (31%) in days in acute hospitals when beds have been occupied by patients who have had their discharge delayed unnecessarily – to the current figure of 1.15 million days.
These figures, however, only accounted for delays after clinicians deemed a patient to be ready for discharge, and did not include all patients no longer in need of acute treatment, said the report.
Based on the evidence it had gathered, the NAO said the true figure for patients aged 65 and older who are no longer benefiting from acute care could be as high as 2.7 million days.
In addition, although overall length of stay for older patients following an emergency admission had decreased from 12.9 to 11.9 days in the last five years – suggesting improved efficiency – the overall number of bed days still increased by 9% from 17.8 million to 19.4 million days.
Among the NAO’s recommendations is that the Department of Health, NHS England and NHS Improvement should set out how they will break the trend of rising delays against the demographic challenge of growing numbers of older people.
However, the NAO noted that it was important to achieve the correct balance between minimising delays and not discharging a patient from hospital before they were clinically ready.
NHS workforce planning has ‘serious shortcomings’
Amyas Morse, head of the National Audit Office, said: “The number of delayed transfers has been increasing at an alarming rate but does not capture the true extent of older people who should not be in hospital.
“While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there,” he said.
“Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government,” he added.
Anna Crossley, professional lead for acute, emergency and critical care at the Royal College of Nursing, said: “Keeping an older person in hospital, when they are well enough and want to go back to their own home, benefits no one.
“Continuing as things are and paring back services when the numbers of older people are rising rapidly is not an option for either patients or NHS finances,” she said. “The NHS needs to be much more ambitious about fixing this now.”
“Investing in community health care means older people can receive more appropriate care which maintains their independence and reduces the pressure on the wider health and social care system,” she said.
Professor Martin Green, chief executive of Care England, said: “The National Audit Office’s report highlights, yet again, the blockages in the system. Often, older people are ready to be discharged from hospital, but they lack the necessary ongoing support.
“The discharge process needs to be better managed and planned; not forgetting the role that care homes can play in offering step-down and intermediary care, if they can be sustained by realistic funding levels,” he added.