What is causing the delays in discharging patients from hospital that have impacted on the ability to admit new patients from A&E?The higher number of patients waiting to be admitted into a hospital bed from A&E than in previous years points not only to patients being admitted when they are sicker, but also to pressure on beds in other parts of hospitals. This leads to disruption in the flow of patients though A&E. Delays in discharging patients prevent beds being freed up for those who need to be admitted, adding to pressures on emergency departments. The number of delayed discharges was relatively stable up until the start of 2014/15 but since then the total number of delays has increased by 19 per cent and numbers now stand at more than 5,000 patients per day who are experiencing a delayed discharge.
Closer analysis of the reasons for these delays suggests that the proportion of delayed discharges attributable to the NHS (caused, for example, by delays in accessing community or mental health services) has risen from around 60 per cent in 2010/11 to more than 68 per cent in 2014/15. The proportion attributable to social care meanwhile has fallen from 35 per cent to around 26 per cent of the total number of delayed days. Around 14 per cent of delays are attributed to patient or family choice. Of the proportion attributable to social care, only a small proportion will be eligible for care funded by the local authority, and waits for public funding account for just 4 per cent of total delayed days (in 2010 it was 8 per cent).
This suggests that capacity and workforce issues, particularly in nursing homes and non-acute services are becoming more important than social care funding issues. With nearly a fifth of delays due to waits for non-acute NHS care, the
need for better co-ordination between different parts of the NHS is just as significant as the need for co-ordination at the NHS and social care interface.The figure below shows the average number of patients delayed per day. It is worth noting that our discussions with some hospital staff suggest that those patients formally recorded as a ‘delayed transfer of care’ only represent the tip of the iceberg and that many more patients are actually well enough to be discharged to home.
Figure 6: Delayed transfers of care: average number of patients delayed per day each monthFor further information:
http://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters