NHS England has been accused by MPs of a “poverty of ambition” over solving the problem of delays in discharging older patients from hospital.
The Commons’ public accounts committee called for new measures to tackle such delays, which it highlighted were “bad for both affect patients’ health and the financial sustainability of the NHS and local government”.
“Delayed discharge is damaging the health of patients and that of the public purse”
A report published by the committee highlighted an “unacceptable variation in local performance” on discharging patients with “patchy” implementation of good practice.
It highlighted some elements of good practice that all local areas should have – including starting assessments and discharge planning early and joint shared patient assessments between health and social care providers.
But the absence of widespread and effective sharing of patient information was “significant barrier” to effective discharge of older patients, the report warned.
It praised Northumbria Healthcare NHS Foundation Trust for recognising the importance of hospital staff being able to access patient information, which had contributed to an excellent record on reducing delayed discharges.
The trust’s new IT system helped hospital staff, community nurses and social workers to access appropriate parts of the GP record, which helped ensure adequate support was in place when patients leave hospital, the report said.
The important role played by community matrons at the trust in sharing patient information and ensuring continuity of care for patients was also highlighted by the committee.
Meanwhile, the Association of Directors of Adult Social Services told the committee there was local variation in the extent to which community matrons were used.
For example, National Audit Office figures showed that the numbers of nurses working in community services had fallen by 13% between 2009 and 2015.
Problems recruiting nursing staff to work in private sector home care, and residential and nursing homes were adding to pressure on the adult social care market, the report warned.
Whistleblowing progress by government ‘too slow’
Most providers of care were private sector organisations and factors, such as local employment markets and whether the local area has full employment, also had an impact on the local markets, it said.
The committee called on NHS England to co-ordinate work to fully understand the cost of delayed discharges.
It also said the Department of Health, NHS England and NHS Improvement must take steps to understand local variations in discharge performance.
Committee chair Meg Hillier said: “Studies indicate older people can lose 5% 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,” she added.
Latest figures – published by the King’s Fund think-tank since the MPs’ report was finalised – show the number of patients medically fit for discharge but stuck in hospital have reached record levels, costing the NHS in excess of £800m a year.
Exclusive: Challenged trusts commit to recruiting nurses
Richard Murray, director of policy at the King’s Fund, said: “The growing and unacceptable delays in discharging patients from hospital highlighted in [the public account committee] report symbolise the twin crises facing the NHS and social care.
“This increase has mainly been driven by delays in arranging social care for patients who need support when they are discharged, a direct result of year-on-year of cuts in social care funding,” he said.
Dawne Garrett, RCN professional lead for older people and dementia, said: “Older people benefit from being able to go home to their own surroundings and familiar routines as soon as possible after a spell in hospital.
“Nurses working in the community can help people manage their conditions at home, and prevent expensive and disruptive hospital admissions,” she said. ”Failing to invest in these services is costing too much, and causing too much distress, to be allowed to continue.”