Healthcare delivery
Delayed transfers from hospital: are there solutions?
Kate Woodhead RGN DMS looks at the reasons behind delayed transfers from hospital, the proposed solutions and strategies, and the challenges ahead.
Prolonged stays in hospital are inconvenient, costly for the hospital and there is evidence that it may have negative effects on patients. Delayed transfers of care out of hospital, and to a place where patient’s care needs can be met, is fraught with difficulty, as well as impacting on the flow of patients into the hospitals. Too many people experience unnecessary delays in discharge. Nearly 350,000 patients spend more than three weeks in acute hospital beds, each year. Many of those people are older patients and
also frail. Their stay in hospital can increase their frailty, increase the likelihood of them getting an infection and reduce their mobility. A reduced length of stay is important for their well being and maintaining independence. However, this is not the experience of many patients. The unfortunate term of ‘bed- blocking’ has been used in the NHS for many years, but is considered to be a derogatory term. Under recent situations, both within the health service and in social care, delayed discharges have not reduced as much as was hoped, putting extreme pressure on hospital bed availability – especially under recent winter pressures. So, what are the main reasons for delays
to discharge? To date there is a scarcity of research related to delayed discharges, but the challenges are identified as: suitable discharge
destinations, capacity of future support to meet their needs, and lack of supply of social care. In addition, waiting for post-hospital care packages accounts for a large proportion of reasons for delays.1
identified in NHS Statistics2
The main reasons for delay are: awaiting care
packages in own home; awaiting nursing home placements and waits for residential home placements; as well as awaiting community equipment and adaptations. The incidence of delayed discharges is compounded by the lack of community beds due to the closure of nursing homes and community hospitals in England. The definition of delayed discharges cites
three situations, which are described as a delayed transfer of care. The Department of Health highlights these as: when a patient is ready for transfer from a general or acute hospital bed but is still occupying the bed; when a clinical decision has been made that the patient is ready for transfer or a multi- disciplinary team decision has been made that the patient is ready for transfer; and the patient is safe to discharge or transfer.3 In 2022, to mitigate the difficulties occurring with delays to transfer patients out of acute care and back to the community, NHS England designed a scheme titled “Discharge to assess, home first”. The scheme suggests that
professionals from discharge teams – from health, social care, housing and the voluntary sector – should work together so that every patient has the opportunity to recover and rehabilitate at home, wherever possible, before their long-term health and care needs and options are assessed and agreed, rather than being discharged into a care home directly from hospital. In my professional opinion, this smacks of political expediency rather than a scheme which has the best interests of the patient at heart. In this system, only limited assessment is carried out in hospital with the focus instead on home assessment and up to six weeks of funded support in the home. Within the scheme, for those whose needs are more than can be supported at home, short-term care and rehabilitation in a residential facility will be arranged.
The English context The differential between healthcare and social care financially is an important factor to consider in this field. As we know, healthcare is publicly funded and free to use, whereas social care is means tested, and is provided by a wide range of both public/ not for profit and privately funded organisations. Social care typically means provision of packages of care, which are comprised of activities of daily living including washing and dressing. However, this is not the whole story, social care is multifaceted and includes home adaptation, day care, and support for family carers. Local authorities have a duty of care and responsibility to work with local providers to ensure that social care needs are met. However, at this time, when local authority budgets are under great strain, many of the services are reduced or under huge pressure. Local authorities have been under even greater pressure as they risk losing funding if they are not seen to be reducing delayed transfers from hospital. There is research which has shown4
patients with specific characteristics tend to be delayed more than others – for example, those with both cognitive impairment and physical
April 2023 I
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that older
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