Patients at local hospitals more likely to experience delays in leaving hospital, despite being fit to leave

Patients under the care of the Northern Care Alliance NHS Foundation Trust – which runs Rochdale Infirmary, Fairfield Hospital, Royal Oldham and Salford Royal – are more likely to experience a delay in being discharged, despite being classed as fit to leave hospital.

That is according to the latest piece of research by the BBC’s Shared Data Unit, which has looked into the extent of delayed hospital discharges - sometimes referred to as ‘bed blocking’ - at acute hospital trusts in England, with patients in the North West more likely to face delays than anywhere else in the country.

Delayed discharges occur when a patient in a hospital bed is classed as medically fit to leave but does not do so at the end of that day, and have been a major concern for hospital leaders for the best part of a decade.

On an average day at the Northern Care Alliance NHS Foundation Trust, 92.5% of patients eligible for being discharged remain in hospital overnight.

On the worst day, 99.6% of patients classed as “no longer meeting the criteria” to be in hospital were still occupying beds at midnight.

The day when the most patients were left in hospital was Monday January 9 2023 when 98 who could have been discharged were still in the hospital at the end of the day.

The proportion of patients ready to be discharged but still occupying beds was worst on Saturdays, when 96.3% of patients identified as ready to be discharged that day were still occupying a bed at midnight.

This was the second highest figure in the North West behind the Stockport NHS Foundation Trust’s figure of 93%, compared to just 20% of patients on an average day at Bradford Teaching Hospitals NHS Foundation Trust.

Looking at the national picture, almost half of delayed discharges were because patients were waiting for care packages to begin in a facility or at home, but many were also waiting for community hospital beds.

Back in April 2013, a study by the Health Foundation found delayed discharges added extra cost to hospitals, hampered their ability to free up space in accident and emergency departments and had a negative effect on, mainly, elderly patients, as this passage from the report explains:

“As a consequence of delayed discharge, some frail patients deteriorated while others were transferred to other parts of the hospital. These transfers sometimes resulted in vital information being lost, resulting in further deterioration, re-work and delay. On average, patients spent four times longer in hospital than was initially estimated by consultant geriatricians involved in their care.”

Ten years on - and despite repeated calls from medical bodies such as the British Medical Association (BMA) to reform the pathways by which patients leave hospital - delayed discharges have followed a generally rising trend, particularly in the winter months.

There were around 60,000 weekly delayed discharges in the winter peak of 2010, compared to a record 140,000 in December 2022.

NHS England recently started publishing aggregated reasons behind the delays at each hospital trust.

Each trust provides a weekly snapshot of the number of people who have remained in a hospital bed for more than 14 days despite being eligible to leave. It breaks that number down into one of 18 categories, or reasons for them remaining. The NHS then publishes a monthly average of those snapshot figures and the reasons given.

Between July 2022 and June 2023, the most reported reason was “awaiting availability of resource for assessment and start of care at home”. This accounted for 24% of all reasons given and was followed “awaiting availability of rehabilitation bed in community hospital or other bedded setting” (23%) and “awaiting availability of a bed in a residential or nursing home that is likely to be a permanent placement (21%).

Reasons relating to delays in clinical decisions, such as awaiting a discharge summary from a doctor and awaiting a diagnostic test account for a relatively small proportion of the reasons given: 16%.

Jude Adams, Chief of Operations at Northern Care Alliance NHS Foundation Trust, said: "We truly believe that the best place for our patients to continue their recovery is in the place that they call home.

"Unfortunately, while we aim to get our patients safely back home as quickly as possible, the increasing pressures across the health and social care system can mean that some of our patients will end up staying in hospital longer than they need to.  

"We currently have several programmes in place to improve the flow of patients through our hospitals such as Same Day Emergency Care (SDEC) and Hospital at Home initiatives that monitor patients virtually with specialty teams and community partners helping our patients to recover in their own home.

"In addition, the NCA is part of the National Discharge Frontrunner Programme that helps us to establish new ways to care for patients who are frail, elderly or living with dementia including ensuring their early discharge from A&E."

The government has made funding available recently to deal with the backlogs in the form of the Adult Social Care Discharge Fund, which has already allocated £500 million to health leaders in order to “support discharge from hospital into the community and bolster the social care workforce”.

The government has also made a ring-fenced £570m available to local authorities through the Market Sustainability and Improvement Fund - to increase their social care workforce in 2023-24 and 2024-25.

A spokesman for the Department of Health and Social Care said: “It is vital people receive the right care in the right place, and we are working to ensure patients are discharged safely from hospital, as soon as they are medically fit to do so. A record £1.6 billion investment is supporting this, on top of the £700 million to ease hospital pressures over last winter and the £42.6 million fund to support innovation in adult social care.”