£100 million Scottish Government funding to improve patient flow
£100 million funding in the 2025-26 Budget to tackle delayed discharge will make Hospital at Home the ‘biggest hospital in the country’, if approved by Parliament.
The service, which offers a safe alternative to admission to an acute hospital, will grow to 2,000 beds by December 2026, alleviating pressure on health and social care settings.
The money will also ensure all A&E departments in Scotland have frailty units directly linked to community care settings, with an increased focus on collaborative working to identify ways to improve patient experience.
It is part of an overall £200 million package to clear the majority of new outpatient and treatment time patient waits and renew the NHS.
Social Care Minister Maree Todd visited Queen Margaret Hospital in Dunfermline to outline a package of measures to reduce delayed discharge and to learn about other services that can be replicated across Scotland, such as Discharge to Assess that has been successful in Fife.
Ms Todd said: “Reducing delayed discharges is a key priority for the Scottish Government and the Budget we published last week will throw the weight of the government behind NHS improvement.
“More than 96% of all hospital discharges happen without delay but we are working with local health partners and local government to find solutions for those that don’t and address the variation we are seeing across Scotland. Our Budget for 2025-26, if approved by Parliament, will provide £200 million to help clear waiting list backlogs, improve capacity and remove blockages that keep some patients in hospital longer than necessary.
“Once someone has been assessed as well enough to be discharged from hospital, the best place for them to be is at home, supported by a bespoke care package. This can be delivered by services for older people such as Hospital at Home, and evidence shows that those benefitting from it are more likely to avoid hospital or care home stays for up to six months after an acute illness.
“We want to expand that service to make it the ‘biggest hospital in Scotland’, providing the very best care, in the comfort of a patient’s own home or home-like setting.
“We have a plan to renew our NHS and the Budget’s record funding for the health service will ensure that 150,000 extra patients are treated, deliver additional support for GPs, and invest in new hospitals at Belford and Monklands.
“We want to improve our NHS, but to do that Parliament must approve our Budget Bill to unlock investment to drive long-term and lasting improvements – and the healthier population that we all want to see. The NHS needs Parliament to unite behind this Budget.”
Scottish care providers call for reform as postcode lottery for elderly patients revealed
Wide regional discrepancies in the speed with which elderly patients declared medically fit to leave hospital are discharged are exposed in ground-breaking new research by the UK’s largest and most comprehensive later-life care directory, Autumna.
The survey of more than 500 care homes and home care agencies has revealed the best and worst performing regions for speed of discharge from hospital, as well as communication between hospital discharge teams and social care providers, with nine in ten providers calling for reform of the system.
100% of care providers questioned in Scotland want the government to reform the hospital discharge process, regardless of whether or not they receive referrals from it. This reflects that the system is among the worst performing in the country.
42.9% of respondents say they don’t have a positive relationship with hospital discharge teams (34% nationally). Only one in five providers receive referrals at least weekly, suggesting a lack of effective communication which may also contribute to slow patient admission: 50% of providers say discharge from hospital takes more than a week (24.3% nationally), with 14.3% saying it takes three weeks or more (nearly twice the national average).
93% of care providers nationally would like to see government reform of the hospital discharge process, with the figure ranging from 85.7% in the North East to 100% of providers in Scotland. Nationally, 85% of care providers who have a positive relationship with their local hospital discharge teams still want the process reformed.
“Our survey, which is the first to probe the experiences of social care providers of the hospital discharge system, shows a system that is failing due to poor relationships caused by poor communication,” warns Debbie Harris, the founder and Managing Director of Autumna, which has developed a digital solution to speed up hospital discharge*.
“Our findings are a wake-up call to Kier Starmer and Wes Streeting that the system is broken and urgently needs reforming. The pressures are only going to get worse as our population gets older, so we need to fix the system now, before it completely breaks down,” she adds.
Delayed hospital discharge costs the NHS around £4.8 million a day1. It also results in: worse health outcomes for elderly patients; other patients not being able to access hospital services; and increased pressure on local authorities, as elderly patients who are stuck in hospital end up with greater care needs.
“Autumna’s Hospital Discharge Report: Care Providers’ Perspectives clearly outlines a system that is failing and will only get worse unless remedial action is taken,” comments Professor Martin Green OBE, Chief Executive of Care England.
“However, this report also highlights the fact that there are solutions, and if people worked effectively with the social care sector and gave it the needed resources, the solutions would be easily and readily available.”
Autumna’s research shows that four in ten social care providers do not receive referrals from hospital discharge teams.
“We have elderly patients stuck in hospital when there is sufficient care to support their discharge, either in a care home or with support at home,” comments Harris. “Hospital discharge teams do not have effective tools to identify available, appropriate care quickly and are overly reliant on some providers, meaning elderly patients are denied access to the full range of appropriate support available to get them out of hospital.”
48.7% of care providers do not feel the hospital discharge teams understand the care they offer. A third of providers (33.4%) say they can’t talk to discharge teams when they need to. Of the care providers who do receive referrals from hospital discharge teams, a similar number (34.0%) say they don’t have a positive relationship with them.
17.0% of care providers questioned say the average length of time for discharge into their care after a patient has been declared fit to leave hospital is one to two weeks, while 7.3% say the average length of time is three or more weeks.
The top reasons for delays in patient transfer to social care providers are because the funding is not agreed, there is insufficient information and lack of communication. 45.5% of care providers say information provided by hospital discharge teams is not accurate. 44.6% of care providers think the information provided by hospital discharge teams is insufficient to make an initial assessment on admission suitability.
“The care sector has the capacity, the expertise and the enthusiasm to be part of the solution,” advises Harris. “What’s more, speeding up hospital discharge will help the commercial viability of providers who face increasingly squeezed margins; 518 care homes closed in 20232, with a loss of 14,169 beds2.
More than 15 million people are projected to be over the pensionable age by 20453, with the number aged 85 and over expected to increase by 1 million to 2.6 million over the same period4.
“With an ever-ageing population, continuing to fail to find a solution to speedy, efficient and appropriate hospital discharges is unsustainable – for the NHS, for local authorities, for the taxpayer, and – most importantly – for our elderly,” urges Harris. “We challenge the government, health and social care leaders to think imaginatively to rise to the challenge.”
For a summary of regional discrepancies, see page 4. For full national and regional results, incl. quotes from local care providers, download the full report: www.autumna.co.uk/hospital-discharge-report-2024/
BOYACK: ‘Delayed discharge is piling pressure on our hospitals’
Scottish Labour MSP Sarah Boyack has warned that delayed discharge in Lothian is “piling pressure on hospitals” as a new report reveals the issue cost NHS Lothian more that £28million in 2022/23.
Delayed discharge figures monitor the number of days patients spend in hospital despite being fit to leave, typically because of a lack of social care services in their area.
Over the course of the year, a total of 97,118 bed days in NHS Lothian were lost to delayed discharge, as rates across Scotland hit a record high.
This includes 70,208 bed days in the City of Edinburgh.
Analysis by Scottish Labour has revealed that the approximate cost of delayed discharge to NHS Lothian in 2022/23 was an eye-watering £28,368,168.
Scottish Labour MSP Sarah Boyack said: “Delayed discharge in Edinburgh is piling pressure on our hospitals and threatening patients’ recovery.
“Our NHS is at breaking point and every penny matters, and it is a scandal that NHS Lothian has been forced to foot a £28million bill for SNP incompetence.
“Social care in Edinburgh and the Lothian is crying out for help, but the SNP’s botched National Care Service plans will do nothing but centralise local services.
“It is high time for the Scottish Government to step up and provide unwavering support for our social care services and increase pay for the sector’s dedicated workers, so no-one is left languishing in hospital waiting for a care package.”
National exercise to re-assess hospital patients who are clinically safe to be discharged
Patients who no longer need to be in hospital are to be reassessed as soon as possible to get them the right care in the right place at the right time.
Before the end of the month each health board area will identify patients who are clinically safe to be discharged without further delay and can safely move home or to another setting such as an interim placement in a care home.
Staying in hospital is not the best option for those who are clinically fit for discharge. Being in hospital for longer than needed is not in the best interests of the individual, particularly for older patients, reducing their ability to look after themselves and return home.
This approach is based on good practice already adopted by several health boards. Patients will only be discharged if it is deemed safe, and clinical risk assessments will take into account the capacity of social care and social work and the potential impact on families or carers of patients.
This is the latest step in efforts to free up capacity in hospitals and help get the NHS through the toughest winter in its history. It builds on last week’s £8 million commitment to provide an extra 300 interim care home beds to get patients discharged quicker.
Health Secretary Humza Yousaf said: “First and foremost, we know hospital is not a good place to be for people who are medically fit to leave, because it can lead to them becoming weaker or less independent. That’s why it’s so important they can move home, or to a homely setting, as soon as possible.
“We believe this will also help to alleviate pressure on our NHS by freeing up beds and improving the flow of patients through hospitals. It is also, crucially, in the best interest of the people concerned.
“If we can reduce delayed discharge there is more chance that beds will be available for people who need them. We hope that these reviews will also contribute to reducing some of the pressures our hospitals are facing.”
Commenting on the latest Urgent and Emergency Care Daily Situation Report 2021-22 that shows nearly one third of patients who were in hospital for 21 days or more were fit for discharge, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“These data reflect the deepening social care crisis.
“We currently have the highest number of long stay patients (21 days or more) since winter 2017-18. Last week, on average, 6,500 beds were occupied by patients who are fit for discharge, and only one in 10 of these patients were able to be discharged daily (on average). All these patients will want to return home and to their communities, but they are unable to because there isn’t the support to aid them upon their discharge.
“There must be a system-wide effort and focus on discharging patients, but such effort will only translate to meaningful action if the government address and take urgent steps to resource social care. Freeing up these beds would help alleviate system pressures, particularly those on Emergency Departments, and promote vital flow throughout the hospital.”
Edinburgh Labour list MSP Foysol Choudhury has slammed the SNP’s failure to end delayed discharge, after it was revealed that it has cost £82,411,987 in the City of Edinburgh over the last five years.
Statistics revealed by Scottish Labour have shown that the total cost of delayed discharge across Scotland has hit over £1bn over the last eight years.
In total, 325,736 bed days have been lost in Edinburgh due to delayed discharge between 2016/17 and 2020/21 with a total cost of £82,411,987.
Local MSP Foysol Choudhury has said that this is symbolic of SNP failure to deliver on its promises and shows the damage done to public health and finances by SNP incompetence.
He warned this will only get worse if the SNP fail to fix the growing crisis in social care, criticising the Scottish Government’s decision not to give carers a fair pay deal in this year’s budget.
TheEdinburgh Labour MSP said:“Never mind the spin and promises, the numbers speak for themselves – SNP incompetence has cost Edinburgh £82,411,987 in delayed discharge alone.
“For years the SNP promised to end this dangerous and costly practice and for years they have failed.
“It is simply unacceptable to have patients left needlessly stranded in hospital and the public purse drained due to poor provision of care for those leaving hospital.
“Things will only get worse if the SNP fail to deal with the crisis in our social care system.
“This makes the SNP’s failure to give carers a fair deal in this budget all the more damaging.
“Ending this costly and dangerous practice must be top of Humza Yousaf’s priority list as we enter the new year.
“This means properly funding social care in Edinburgh and giving staff the real pay rise they so badly deserve.”
There was a total of 562,062 instances of staff absences
249,173 instances of staff absences were covid related, an increase of 41% on the previous week
Nearly half of instances of staff absences were covid related
Since the start of December there has been an increase of 198% in covid-related instances of absence
On average 16,906 patients resided in hospital who no longer fit the criteria and were ready to be discharged, of these, on average, 9,858 remained in hospital
This is equal to almost six in 10 patients who were ready to be discharged remaining in hospital
Nearly one quarter of ambulance arrivals were delayed by 30 minutes or more
Almost one in 10 ambulance arrivals were delayed by at least an hour
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The scale of the pressures facing the health service is highlighted in these figures. Instances of covid-related absence have tripled since the beginning of December. Now the army has been deployed to assist the health service in London.
“Ambulances continue to be delayed in handing over patients on arrival putting patient safety at risk, while high numbers of patients ready to be discharged remain in hospital due to the ongoing social care crisis.
“Promoting flow through the hospital is vital but rests upon timely discharge of patients back home once their treatment is complete. To ensure this social care must be resourced and supported, this will help reduce admissions and free up beds in hospital.
“It is a perilous situation, and an enormous strain is put upon staff working in hospitals, who continue, as ever, to go above and beyond to ensure care continues to be delivered and patients are kept safe.”
The number of days that patients who have been delayed from leaving hospital because of no appropriate place to go to has risen to 7,829 for July 2021, the latest month statistics are available for.
This is an increase of 2,004 from 5,825 delays throughout June and triple the number of bed days occupied from delayed discharge at the start of the Covid-19 pandemic when 2,531 delays occurred.
At the start of the Covid-19 pandemic SNP Ministers made the decision to move hospital patients into care homes, to free up hospital space for dealing with the Covid-19 pandemic. It later emerged that patients being moved from hospitals to care homes where not tested for Covid-19 leading to higher rates of Covid-19 deaths in care homes than anywhere else in Scotland.
The level of delayed discharge in NHS Lothian has now returned to pre- pandemic levels with the number of bed days in hospital for delayed discharge being 11 higher than March 2020, 7,278, when hospital patients where moved to care homes.
Edinburgh and the Lothians were in the process of recovering from a Social Care crisis before the pandemic hit, with the peak of delayed discharge in hospitals being in October 2018, when 11,855 combined days when patients were not able to leave hospital, despite being back to health.
Lothian MSP, Miles Briggs, said: “These figures are very concerning, with the number of patients being stuck in hospital without a suitable destination, returning to pre pandemic levels.
“In Edinburgh and the Lothians there has been a long standing challenge to provide social care, which started to shift towards care in the community.
“We are now seeing increasing numbers of patients not able to leave hospital and the Edinburgh Integrated Joint Board are planning on closing more care homes.
“Patients leaving hospital must have a suitable destination to go once recovered, so that we are not in a position where people are waiting days on end in hospital, when they don’t need to be there.”
‘in many areas of Scotland, the integration of health and social care is happening in name only’
The loss of over half a million bed days in Scotland’s hospitals over the past year is a symptom of the failure to integrate health and social care, according to the disability charity Leonard Cheshire in Scotland.
Figures published by ISD Scotland show that a total of 542,204 bed days in 2019/20 were occupied by people delayed in their discharge from Scotland’s hospitals.
This represents a 4% rise in the number of bed days lost due to delayed discharges between 2018/19 and 2019/20. A daily average of 1,481 beds were occupied by people delayed in their discharge over the past year.
A delayed discharge occurs when a person, clinically ready for discharge, cannot leave hospital because the necessary care, support or accommodation required is not readily accessible or funding is not available, for example to purchase a care home place.
The main reasons for patients being delayed in their discharge in 2019/20 were awaiting completion of care arrangements (35%), awaiting place availability (23%) and awaiting community care assessment (17%).
ISD Scotland estimates that in 2017/18 alone, the cost of delayed discharges in NHS Scotland was £122 million – with an estimated average bed day cost of £248.
Reacting to the figures, Leonard Cheshire in Scotland’s Director Stuart Robertson said: “These figures demonstrate that in many areas of Scotland, the integration of health and social care is happening in name only.
“More than half a million bed days have been lost over the past year in Scotland’s hospitals due to delayed discharges and it’s time the Scottish Government finally tackle this issue. Over half of patients who experienced a delayed discharge have been impacted by a lack of care arrangements, availability and assessments.
“Delayed discharges are costing the Scottish Government over a hundred million pounds every year and are badly letting down disabled people and those receiving health and social care.
“Investment on the frontline is urgently required if we are to end delayed discharges and create a person-centred health and social care system that truly meets the needs of the Scottish people.”
