MPs call for social care integration rethink to reduce hospital discharge delays

The widening gap between rising demand for social care and its availability is impacting on efforts to cut the number of people stuck in hospital, a report has found.

MPs on the Commons Public Accounts Committee are calling for new strategies to reduce the numbers of people in hospital who are medically fit to leave – now at its highest ever level.

Figures for May show the equivalent of 171,500 days were lost due to delayed discharges, with estimates suggesting the figure across a year could be as high as 2.7 million bed days lost.

A snapshot survey carried out on the last Thursday of May showed there were 6,000 patients stuck in hospital beds, compared to 5,000 the previous year.

One of the reasons for delays is that no appropriate package of social care is available in the community to enable elderly people to leave.

The new report said delays were bad for elderly patients’ health and “increase the level of care they may need after leaving hospital”.

The National Audit Office (NAO) has estimated costs to the NHS of around £800 million a year for delayed discharges.

The committee said that, despite efforts to control the problem, the Department of Health and NHS England “rely too easily on differing local circumstances as a catch-all excuse for not securing improvement in performance”.

It said they should do more to step up the process of integrating services to bridge the gap between health and social care, and criticised the lack of sharing of patient information as one of the reasons for delays.

But it also blamed a drop in funding for care home places, saying local authority spending on adult social services had fallen by 10% in real terms between 2009/10 and 2014/15.

“This is putting pressure on local authorities to reduce fees which in turn puts pressure on care providers,” it said.

The report highlights evidence from NHS England 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 this would “prevent significant progress being made in reducing delays over the next five years.”

But the committee said funding problems should not block efforts to make further improvements and maintaining the status quo on delayed discharges should not be seen as a success.

Labour MP Meg Hillier, chairwoman of the committee, 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.

“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.”

She added: “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.”

Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “Delayed discharges are costly to the NHS and traumatic for patients, and their families and carers.

“Well-integrated, community-based services are critical to enabling safe, swift and cost-effective discharges. However, the continuing squeeze on local authority spending risks creating a system in which delayed discharges are the new normal.”

A Department of Health spokesman said: “Elderly patients should never be forced to stay in hospital unnecessarily – we are determined to make health and social care more integrated.

“Local authorities will have more money – up to £3.5 billion extra – for adult social care by 2019/20 and by 2020 we will be investing an extra £10 billion a year so the NHS can introduce its own plan for the future and help fewer people go to hospital in the first place.”

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