Tag: delayed discharge

£28.3 million delayed discharge price tag in NHS Lothian

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.”

Delayed discharge 2022/23 – Health Board

Delayed discharge bed days (age 18+) Estimated cost   
Scotland        661,705£193,284,031
NHS Ayrshire & Arran          70,677£20,644,752
NHS Borders          23,079£6,741,376
NHS Dumfries & Galloway          35,692£10,425,633
NHS Fife          40,379£11,794,706
NHS Forth Valley          41,946£12,252,427
NHS Grampian          40,413£11,804,637
NHS Greater Glasgow & Clyde        132,862£38,808,990
NHS Highland          50,566£14,770,329
NHS Lanarkshire          67,388£19,684,035
NHS Lothian          97,118£28,368,168
NHS Orkney            2,312£675,335
NHS Shetland            2,054£599,973
NHS Tayside          52,316£15,281,504
NHS Western Isles            4,903£1,432,166

Delayed discharge 2022/23 – Local Authority

Delayed discharge bed days (age 18+) 
Scotland661,705
Aberdeen City8,945
Aberdeenshire16,832
Angus6,407
Argyll & Bute11,944
City of Edinburgh70,208
Clackmannanshire4,983
Comhairle nan Eilean Siar5,185
Dumfries & Galloway35,511
Dundee City20,286
East Ayrshire9,943
East Dunbartonshire7,607
East Lothian3,251
East Renfrewshire4,652
Falkirk25,500
Fife43,363
Glasgow City74,875
Highland44,897
Inverclyde5,241
Midlothian9,377
Moray14,123
North Ayrshire22,316
North Lanarkshire37,801
Orkney2,427
Perth & Kinross23,700
Renfrewshire7,006
Scottish Borders23,406
Shetland2,142
South Ayrshire40,432
South Lanarkshire41,970
Stirling9,803
West Dunbartonshire13,905
West Lothian13,102

Source: https://publichealthscotland.scot/publications/delayed-discharges-in-nhsscotland-annual/delayed-discharges-in-nhsscotland-annual-annual-summary-of-occupied-bed-days-and-census-figures-data-to-march-2023/
 

Cost per bed day is estimated at £292.10 by adjusting the most recent estimated cost for inflation using the SPICe real terms calculator.   

Action to cut delayed discharge

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.”

Additional Winter support for NHS

Social care crisis must be addressed, says Royal College of Emergency Medicine

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.”

The latest Urgent and Emergency Care Daily Situation Report 2021-22 for the week 10 – 16 January 2022 show:

  • As a daily average 17,541 patients stayed in hospital for 21 days or more
  • As a daily average 6,495 of these long-stay patients were fit for discharge, this is equal to nearly one in three
  • On average only 656 patients were discharged daily, equal to just one in 10

Local MSP slams £82.5 million bill for delayed discharge in Capital

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.

The Edinburgh 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.”

Delayed discharge 2016-17 to 2020-21:

Local authority of residenceTotal Bed Days lostTotal Costs
Scotland2,448,948£623,641,618
Aberdeen City77,922£19,421,606
Aberdeenshire74,507£18,812,235
Angus29,759£7,593,790
Argyll & Bute37,964£9,687,010
City of Edinburgh325,736£82,411,987
Clackmannanshire16,149£4,155,811
Comhairle nan Eilean Siar32,742£8,267,394
Dumfries & Galloway69,290£17,710,667
Dundee City52,217£13,206,196
East Ayrshire23,196£5,889,582
East Dunbartonshire21,952£5,675,305
East Lothian41,985£10,469,017
East Renfrewshire10,978£2,805,220
Falkirk87,703£22,374,280
Fife171,809£43,936,581
Glasgow City202,643£52,290,504
Highland187,903£47,838,848
Inverclyde8,444£2,139,961
Midlothian52,311£13,330,822
Moray55,017£13,953,009
North Ayrshire78,324£20,076,967
North Lanarkshire179,598£45,912,014
Orkney6,365£1,627,198
Other2,427£612,271
Perth & Kinross68,060£17,087,463
Renfrewshire31,950£8,342,877
Scottish Borders59,496£15,215,448
Shetland6,017£1,523,845
South Ayrshire100,431£25,776,248
South Lanarkshire194,721£49,369,081
Stirling36,757£9,374,287
West Dunbartonshire26,849£6,997,222
West Lothian77,726£19,756,872

Source: https://www.publichealthscotland.scot/publications/delayed-discharges-in-nhsscotland-annual/delayed-discharges-in-nhsscotland-annual-annual-summary-of-occupied-bed-days-and-census-figures-data-to-march-2021-planned-revision/

Emergency care crisis deepens

The latest Urgent and Emergency Care Daily Situation Reports 2021-22 for week ending 2 January 2022 show:

  • 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.”

Delayed Discharge in NHS Lothian returns to pre Covid-19 levels

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.”

Half a million lost bed days are symptom of poor care integration, says disability charity

‘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.”

Briggs: blame Scottish Government for delayed discharge crisis

Extent of the impact social care crisis is having on delayed discharge in Lothian revealed

Latest figures for delayed discharge, from the Delayed Discharge NHS Scotland (Annual Release) show the extent of the challenge facing Integration Joint Boards in Lothian. Continue reading Briggs: blame Scottish Government for delayed discharge crisis

Briggs: Critical Care delayed discharges at the Western General remain highest in Scotland

This week’s Audit of Critical Care in Scotland report has revealed that the critical care unit at the Western General Hospital in Edinburgh has significantly higher delayed discharge rates than the rest of Scotland. Continue reading Briggs: Critical Care delayed discharges at the Western General remain highest in Scotland