Half of Addenbrooke’s Hospital patients ready to go home face discharge delay
Ninety-nine patients passed as fit to go home were left in hospital on the worst day for delayed discharges at Addenbrooke’s, new data reveals.
The problem, which is often referred to as ‘bed-blocking’, occurs when a patient is medically well enough to leave hospital, only for something to cause a hold-up – often a lack of social care places in the community.
It reduces the number of available beds on wards and contributes to patients brought into accident and emergency departments not being admitted swiftly.
On an average night between July 1, 2022 and June 30, 2023, some 48.1 per cent of patients at Cambridge University Hospitals NHS Foundation Trust (CUH) who had been identified as ready to be discharged that day were still occupying a bed at midnight.
This is 9.7 percentage points lower than the average figure for trusts across England (57.8 per cent).
On three days, 76.9 per cent 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 Saturday, December 3, 2022 when 99 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 Sundays, when 66.8 per cent of patients identified as ready to be discharged that day were still occupying a bed at midnight.
CUH fares better than most in the East of England region, where it is ranked 10th out of 13 in a table ranking the highest proportion of undischarged patients, according to data from the the BBC shared data unit.
The worst was James Paget University Hospitals NHS Foundation Trust in Great Yarmouth, where an average of 64.1 per cent of patients ready for discharge were still occupying a bed at midnight on the period studied.
Delayed discharges have been a major concern for hospital leaders for the best part of a decade.
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
The report said: “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, rework 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.
Patricia Marquis, director for RCN England, said: “No patient should spend longer in hospital than necessary, but a lack of social or home care is leaving many waiting to be discharged – when they should be getting more appropriate care elsewhere.
“At the heart of this is persistent understaffing across all care settings – but particularly in social care. We would like to see a long-term plan for social care that matches the ambitions of the recent NHS Long-term Workforce Plan. Put simply, we need more nursing staff in the community and social care sector.
“Nursing staff will do everything they can to provide the right care for all their patients but without the investment to grow the whole of the nursing workforce, they will continue to face massive pressures and it is their patients who will pay the price.”
A lack of capacity in the care system has long been considered part of the cause, but another large proportion stems from the limited availability of beds in NHS-run community hospitals.
The government has made funding available recently that aims to deal with the backlogs. The Adult Social Care Discharge Fund 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. Although it has been welcomed, medical leaders say this is still a short term solution to a wider problem.
Caroline Abrahams, charity director at Age UK, said: “Behind these statistics are real people, the vast majority of them older, who had to endure the misery of being stuck in a hospital bed for far longer than was good for them, potentially undermining their chances of making a good recovery. This is so sad for them and their families and a waste of NHS resources, so looking ahead to this winter it is vital that the health and care system works better in discharging older people from hospital once they are medically well enough to leave.
“We know that many lessons have been learned from the bad experiences last winter and that huge efforts are being made to gear up the NHS to perform better in terms of discharges when the pressure intensifies in a couple of months’ time. New innovations like community-based falls services, hospital at home teams and local care hubs should all help, but the continuing lack of social care, especially at home, remains a serious problem in many places.
“Unless and until a government really grips social care and the need to pay care professionals more - not just over the winter but as part of their basic pay - many older people will be at risk of longer hospital stays than are strictly necessary.”
A spokesman for the Department of Health and Social Care (DHSC) responded: “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.
“To further bolster the workforce, we are continuing our Made With Care recruitment campaign – designed to reach millions of people – and the average pay for care workers has also increased.
“Staff retention is equally as important, which is why we are also investing almost £2billion over two years to help councils support the workforce.”
Cambridge University Hospitals NHS Trust was approached for comment.