Analysis of official data by Guardians shows that an average of 13,600 beds across NHS England are taken every day with patients who doctors say are medically fit to go home or into a care home, equivalent to one in seven beds in acute hospitals in October. However, this rose to more than one in five in 35 of England’s 121 acute hospital trusts and almost one in three in two trusts – North Bristol and Wrightington, Wigan and Leigh NHS. Graphic map Previous work by the Nuffield Trust has revealed that the majority of late discharges are due to a lack of social care, whether it is support in patients’ homes or placement in a care home. The situation has worsened sharply at 35 hospitals, including Epsom and St Helier University Hospitals in London – where late discharges rose from 6% in April to 20% in October – and Liverpool University Hospitals, which rose from 10% to 23% within the same period. “There is definitely a sense that this is getting worse,” said Miriam Deakin, director of policy and strategy at NHS Providers. graphic The figures come as the NHS prepares for what is expected to be one of the toughest winters yet, with flu, Covid and record NHS staff vacancies putting pressure on the system. NHS England announced last month that it was setting up system control centres, or ‘war rooms’, to cope. Earlier this month, Sarah McClinton, chair of the Association of Directors of Adults’ Social Services, said the state of social care in England had never been worse, with half a million people waiting for help. “The shocking situation is that we have more people seeking help from councils, more elderly and disabled people with complex needs, yet social care capacity has fallen and we have 50,000 fewer paid carers,” he said. Rishi Sunak is reportedly considering delaying social care changes announced by his predecessor, Boris Johnson, which would have put an £86,000 cap on how much people have to pay for care. It is thought that delaying the policy will save the government £1 billion in the first year, rising to £3 billion if it is scrapped entirely. The impact of delayed discharges on new patients has long been evident, with A&E departments heavily overcrowded and ambulances queuing outside hospitals, unable to take patients back on the road. But the effect on patients stuck in the hospital can also be profound. “Your muscle capacity can deteriorate in a hospital bed – and that’s very quickly for older people actually – your mental health can suffer, you can lose your independence very quickly,” Deakin said. Speaking to the Guardian, one patient described becoming depressed and losing hope after being told he was 26th on the waiting list for a rehabilitation placement, while another described how his mother suffered a broken hip and severe cuts to her shin in accidents that happened while waiting to be discharged. Professor David Strain of the British Medical Association and the University of Exeter’s medical school said those unable to leave hospital because they are waiting for social care are a vulnerable population. “Very often they will be physically disabled or have early or even deep dementia,” he said. Strain added that moving such patients, for example to a ward of people awaiting discharge, can reignite delirium, meaning patients are instead kept in the same hospital bed. “That means they’re often sitting on medical wards, with patients coming in, very unwell … and I mean in the time of Covid, people literally walking in and dying in the beds next to them,” Strain said. Archie Bland and Nimo Omer take you to the top stories and what they mean, free every weekday morning Privacy Notice: Newsletters may contain information about charities, online advertising and content sponsored by external parties. For more information, see our Privacy Policy. We use Google reCaptcha to protect our website and Google’s Privacy Policy and Terms of Service apply. Strain said long delays could mean patients begin to lose the ability to care for themselves, even when it comes to simple tasks like choosing their clothes. “The weeks that people end up waiting for appropriate care to become available further institutionalize them and make it almost impossible for them to return home,” he said. Patients can also acquire infections while confined to the hospital and suffer falls due to the unfamiliar environment and increasing weakness. Strain said rejection delays can range from about a week to a few months. “It’s a big concern both for the patients who are victims of this and for other patients who can’t get into the hospital beds they need [them]Strain said. Professor Martin Green, chief executive of Care England, said the personal impact on people was beyond measure. “What we see is [that] delayed discharges often result in people becoming much more dependent than they would have been if they had been discharged properly,” he said, adding that this can be traumatic for the person themselves. A major problem affecting social care is lack of funding, he said. “Some local authorities pay [care workers] £6 an hour for 24-hour care, three meals a day, supporting people with a lot of co-morbidities, having to do all the personal care stuff,” Green said. “How is that?” Deakin agreed. “Not enough money is flowing from the government through local authorities to pay for social care. And that has an impact on the wages that care providers can offer their staff,” he said. A spokesperson for the Department of Health and Social Care said: “We are investing £500m of extra funding to speed up the safe discharge of patients from hospital and recruit and retain more care workers to support people who no longer need to be in hospital. The NHS is also creating the equivalent of 7,000 extra beds this winter – allowing hospitals to treat patients faster, including by using remote monitoring to provide care at home or in the community. “Alongside this, the NHS discharge taskforce is working directly with NHS trusts experiencing the longest discharge delays to ensure best practice is being implemented.” The Guardian recently revealed how hospitals and care services have not received a penny of the £500m funding to speed up patient discharges promised by the government. Ministers said they were injecting the cash into the health and social care system on September 22. However, the Guardian has found that none of the funding has materialised.
