Significant Change Needed, says new report
NHS Scotland spent £440m last year on beds for patients who were unable to get out of hospital despite being ready to be discharged, according to a new report by Scotland’s public spending watchdogs.
The report from the Audit Scotland and the Accounts Commission said one in nine hospital beds were occupied because of delayed discharges in the 12 months to April 2025.
It said the Scottish government must set out a plan to tackle the problem.
Delays in discharging patients from hospital affect people’s physical and mental health, and make it harder to admit others to hospital. Delayed discharges are a symptom of wider pressures across health and social care in Scotland.
The joint report by the Auditor General for Scotland and the Accounts Commission warns this has a significant effect, despite impacting only around three per cent of hospital patients. People medically ready to leave spent 720,000 unnecessary days in hospital in 2024/25. Whilst the full financial impact is unknown, the cost to the NHS in hospital days alone is an estimated £440 million a year.
The causes are complex, including rising demand for health and social care services, financial pressures, long-standing recruitment and retention problems across Scotland and for some, not having a Power of Attorney in place.
Reducing delayed discharges is a priority for the Scottish Government and their partners in health and social care, with significant activity underway to tackle this. But a lack of evaluation of initiatives across the country means it is difficult to measure what is having the greatest impact and whether these initiatives represent value for the money and time spent.
Stephen Boyle, Auditor General for Scotland, said: “Delayed discharges from hospital have far-reaching impacts on people’s health and well-being. The Scottish Government, health bodies, councils and other partner organisations agree on the need for major changes and are actively trying to reduce delayed discharges.
“Now they must improve how they collect, analyse and use data to evaluate the initiatives underway to tackle the problem. Without this, it’s impossible to understand the impacts and costs of delayed discharges and whether the initiatives across Scotland are improving lives, services and delivering value for money.”
Malcolm Bell, Member of the Accounts Commission said: “Significant change is critical across our health and social care services, shifting towards preventative care, greater use of technology and ongoing investment in the workforce. Without this, the care and support individuals need to leave hospital won’t always be available.
“The Scottish Government and COSLA’s joint health and social care service renewal framework is an opportunity for progress to be made with health and social care reform. But IJBs and social care need to be at the centre of planning and decision-making on service renewal, and it’s not clear how the framework will address the challenges faced by social care.”
‘The current approach has failed’
In response to the joint report into delayed discharges by the Auditor General for Scotland and Accounts Commission, Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This report lays bare the scale of delayed discharge, and the impact it has on our health and social care system and the people it serves.
“720,000 days’ worth of unnecessary hospital stays in the 2024/25 financial year. That’s almost 2,000 years – an almost inconceivable amount of wasted resources which, if exit block had been addressed, could be used to help the patients lining the corridors of Emergency Departments day in, day out.
“The knock-on effect delayed discharge has on EDs cannot be overstated.
“Every hospital bed occupied by someone who does not need it, but cannot leave through no fault of their own, adds pressure to EDs which are receiving more patients than they can move on.
“And these unnecessary stays in a hospital bed puts patients at greater risk of hospital-born infection, and can lead to deconditioning, stripping them of their independence.
“This is something RCEM has been raising the alarm about for years now, and while the government has acknowledged the issue and taken some steps to address it – the total breakdown in hospital flow outlined in this report shows that the current approach has failed.
“Things cannot go on like this and I hope the government, health service and local authorities heed the recommendations set out by the Auditor General for Scotland.
“Improvements to data gathering and discharge planning, among the other recommendations, would be a step towards the system-wide approach we have long said is needed to fix Emergency Care.”
RCEM said earlier this week that The Scottish government must prioritise tackling delayed discharges and overcrowding in Emergency Departments (EDs) or risk the entire system collapsing under the strain of an incredibly difficult winter.
Th message from the Royal College of Emergency Medicine (RCEM), followed the release of ED performance figures on Tuesday (6 January) by Public Health Scotland (PHS) for November 2025.
One in 15 patients (8,065) waited 12 or more hours in a type-1 ED before being admitted, transferred or discharged in that month alone, the worst figures for a November since records began in 2007.
Further, the new data found that:
- It was the worst November on record for eight-hour waits, which stood at 17,259, or 14.5% of patients attending a major ED
- Only 63% of patients seen within four hours at type-1 EDs, a far cry from the government target of 95%
- Compared to November 2018, waits of four or more hours were four times higher, eight-hour waits were 14 times higher, and 12-hour waits were 39 times higher
- Meanwhile, the number of people attending ED was only 5.5% higher in November 2025 compared to November 2018
Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This is yet another month of predictable broken records for Emergency Medicine performance in Scotland.
“The Scottish government continues to shout about improvements to NHS waiting lists. We, of course, welcome these but a lack of political will to put the same emphasis on addressing delayed discharges means our departments are at risk of total derailment.
“We are now in the depths of winter. Patients are arriving into EDs only to find that there isn’t the space to treat them safely, let alone quickly.
“Very sick and injured people are lining corridors, crammed into whatever space we can find, because of exit block and a complete breakdown in flow out of hospitals.
“With warnings of storms, snow and freezing temperatures, the situation is likely to get a lot worse before it gets better.
“It’s unacceptable that this has been allowed to happen, but it’s not too late to act. We call on the government to support health boards so they can make the improvements needed to tackle delayed discharges and improve patient flow.”
