As the winter months bring a surge in flu, Covid, and norovirus cases, hospitals across the UK are struggling to cope with the influx of patients. But the real crisis lies not with these seasonal illnesses, but with the thousands of patients who no longer need hospital care yet remain occupying precious beds.
According to the latest figures from NHS England, there are over 13,000 people in England alone whose treatment has been completed but are still taking up hospital beds. This accounts for around one in eight beds being occupied by individuals who could be cared for elsewhere. The situation is similarly dire in the rest of the UK, with a further 4,000 such “delayed discharge” patients.
The cost of this crisis is staggering. With each hospital bed costing an average of £562 per day to staff and maintain, the NHS in England is losing more than £225 million a month supporting patients who could be better cared for in the community. This financial burden is compounded by the impact on other patients, with surgeries being cancelled and long A&E wait times due to the lack of available ward beds.
The issue of delayed discharges is not a new one, and successive governments have pledged to address it. Last summer, the government launched an urgent and emergency care plan, promising improvements. However, the problem remains deeply entrenched, raising questions about the coordination and planning within the healthcare system.
“It takes a lot of time and effort to discharge a patient,” explains Emma Dodsworth, a researcher who has studied the issue for the Nuffield Trust think tank. “Some may need adaptations to their home, some short-term help with washing and dressing or home visits from nurses. Some a combination of all three, while others may need a care home place to be found.”
The solution lies in better integration between the NHS and local authority-run social care services. At the Queen Elizabeth Hospital in Gateshead, a successful model has been implemented, with social workers and nurses working side-by-side in a dedicated discharge liaison hub. This approach has consistently resulted in quicker discharges than the national average.
However, Kerrie Allward, a policy lead for the Association of Directors of Social Services (ADASS), warns that such cooperation is “inconsistent” across the country, with relationships sometimes becoming “frictional”. She argues that a critical issue is the lack of funding for social care, with local government spending squeezed over the past decade, making it difficult to invest in the integrated services needed to support timely discharges.
Looking to other European countries, Denmark has taken a different approach, creating a network of “intermediate care beds” in community hospitals and care homes, staffed by nurses and carers. This allows patients to be discharged from acute hospitals while still receiving the support they need.
The University Hospitals of Leicester NHS Trust has adopted a similar model, purchasing and renovating a former care home called Preston Lodge. Staffed by nurses, physiotherapists, and occupational therapists, with its own GP, Preston Lodge allows patients who are medically fit to leave the hospital while continuing to receive the care they require.
However, the lack of integration between social care and the NHS remains a significant obstacle to this approach being used more widely. Additionally, the attitudes of some families, who prefer their loved ones to remain in the hospital setting, present another challenge.
Dr. Vicky Price, an acute medical consultant, suggests that the medical profession itself may also bear some responsibility, arguing that around a third of hospital admissions are for patients in their last year of life. “We admit them and end up over-treating them with interventions, scans and pills,” she says, arguing that a more palliative approach focused on managing symptoms and improving quality of life would be preferable.
As the NHS continues to grapple with this crisis, it is clear that a multifaceted solution is needed. Improving coordination between health and social care, investing in community-based services, and rethinking end-of-life care are all crucial steps to easing the strain on hospital beds and ensuring patients receive the most appropriate care.
