Low funding ‘not an excuse’ for poor ambition to fix delayed discharges

Despite recognising the existing funding pressures on both the health and social care sectors, MPs have today argued that NHS England “shows a striking poverty of ambition” to tackle the growing issue of discharge delays – which has hit yet another record high in the latest performance figures.

In a scathing report looking into the scale and costs of discharge delays, the Commons Public Accounts Committee (PAC) said funding issues should not necessarily “block efforts to make further improvements”, and urged NHS England to show greater commitment to “step up the pace of change”.

These warnings come just a few weeks after NHS England boss Simon Stevens admitted that the problem may not be dealt with for at least four years. In the PAC inquiry, Stevens noted he couldn’t say when the NHS would be able to achieve 0% delayed transfers, because it was “going to be battling some very substantial headwinds over the next two, three, four years”.

The report reiterated the National Audit Office’s warnings from May that official data on delayed discharges “substantially underestimates” the range of delays and the number of older people affected.

It also highlighted the “significant barrier” of poor information sharing and the extra strain that “the fragility of the adult social care provider market” places on discharges.

MPs in the committee called on NHS England, NHS Improvement and the Department of Health to work harder to understand the reasons for major local variations in discharge performance – concluding that while good discharge practice is well understood, implementation is “patchy”.

NHS England must also co-ordinate work to “fully understand” the costs of delayed discharges to hospitals and community care, the committee said.

In her statement, Meg Hillier, the PAC’s outspoken chair, quoted studies that indicate older people can lose 5% of muscle strength per day of treatment in a hospital bed – meaning delayed discharges can be really damaging to patients’ health.

“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. “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. NHS Improvement should move faster to ensure such approaches are widely adopted.”

Hillier added that evidence shows discharge performance is largely helped by effective local co-ordination between health and social care organisations, “sometimes in fully integrated systems”. And according to health secretary Jeremy Hunt, sustainability and transformation plans (STPs) – designed to drive integration at regional and local level – should be “very simply” about reducing hospital bed days.

The PAC chair continued: “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.”

Industry support

The report garnered support from prominent national bodies, including leading think tank The King’s Fund – whose director of policy, Richard Murray, said the report’s findings “symbolise the twin crises facing the NHS and social care”.

He also cited the latest performance figures, claiming that unnecessary bed occupation and delayed discharges cost the NHS in excess of £800m a year, as well as “imposes a significant human cost” on patients and families.

“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,” Murray added. “However, the majority of the delays are caused by NHS-related problems, with significant variation in local performance.”

Like Hillier, Murray endorsed effective integration, arguing delayed discharges are “too often” down to poor collaboration between services, as well as failures to share data and inadequate processes.

NICE’s deputy chief executive and director of health and social care, Professor Gillian Leng, took the opportunity to highlight the body’s guidance that “aims to improve the situation” some patients are finding themselves in.

“Our social care guidance, ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’, makes recommendations that will help make the move from hospital to home as painless as possible for patients,” she said. “For example, we recommend that one person, either from the hospital or community-based team should be made responsible for a patient’s discharge from hospital.

“It’s important that our guidance and recommendations are implemented and embedded into the culture across health and social care. The message is clear, the focus should always be on the patient.”

Responding to today’s findings, a spokesman from the Department of Health argued councils will have more money – “up to £3.5bn extra” – for adult social care by 2019-20, and said by 2020 central government will be investing an extra £10bn a year so the health service “can introduce its own plan for the future and help fewer people go to hospital in the first place”.


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(Top image c. Design Council and Andy Smith)


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