Government shows 'striking poverty of ambition' on discharge delays

22 July 2016

The Public Accounts Committee report challenges the Government to address the scale and cost of delays in discharging older patients from hospital, concluding: "Patients and the NHS have a right to expect better."

Report conclusions and recommendations

The Committee's report  urges new measures to tackle discharge delays, which are bad for both patients' health and the financial sustainability of the NHS and local government.

The Committee finds there is a poor understanding of the scale of discharge problems, with official data substantially under-estimating the range of delays and the number of older patients affected.

There is unacceptable variation in local performance on discharging such patients, says the Committee, finding that while good discharge practice is well understood, "implementation is patchy across local areas".

It concludes poor sharing of patient information is a significant barrier to improving performance, while "the fragility of the adult social care provider market" exacerbates discharge difficulties.

Gap between availability and demand for adult social care widening

The Report highlights evidence given by NHS England that pressure on local authority funding "would see a widening gap between the availability of, and the demand for, adult social care over the next few years" and that this would "prevent significant progress being made in reducing delays over the next five years".

While it recognises there is pressure on funding, the Committee does not accept this necessarily blocks efforts to make further improvements and urges a greater commitment to step up the pace of change.

It concludes: "NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement."

Local variations in performance must be understood

The Committee calls on NHS England to coordinate work to fully understand the cost to hospitals of delayed discharges and the costs, where these fall on the public purse, of caring for these people in the community.

The Department of Health, NHS England and NHS Improvement must also take steps to understand the reasons for local variations in discharge performance.

Further recommendations, including measures to improve the sharing of good practice and information, are detailed the Report.

Chair's comments

Meg Hillier MP, Chair of the PAC, said:

"Studies indicate older people can lose five per cent of muscle strength per day of treatment in a hospital bed.

Delayed discharge is damaging the health of patients and that of the public purse.

While there have been improvements, the Department of Health and NHS bodies are still failing to properly address the root causes of this problem.

Blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out when the Government has clear indicators of what works and the power to drive change.

Best practice can be as simple as planning a patient’s discharge early in their hospital stay, or conducting shared patient assessments between health and social care providers. NHS Improvement should move faster to ensure such approaches are widely adopted.

Evidence also shows that discharge performance is best where local health and social care organisations work together effectively, sometimes in fully integrated systems. The Government must learn from this and push the pace of integration where evidence supports doing so.

This Committee is vividly aware of the financial pressures facing the NHS but does not accept maintaining the status quo is an adequate ambition – particularly when the consequence is additional costs running to hundreds of millions of pounds.

Improving discharge performance is critical to the well-being of patients and the public finances and we challenge the Government to deliver the benefits we would expect from a greater hands-on commitment to this goal."

Report summary

Increasingly, older patients are experiencing delays in being discharged from hospital. Such delays are bad for their health and increase the level of care they may need after leaving hospital.

Unnecessary delays are also bad for the financial sustainability of the NHS and local government and the National Audit Office (NAO) has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there.

While it is clear there have been improvements and many in the NHS and local government are putting in significant efforts, the Department and NHS England rely too easily on differing local circumstances as a catch-all excuse for not securing improvement in performance. They should be doing more to increase the pace of integration and make local accountability systems more effective.

"Unacceptable" variations in local performance

Those areas which are doing best are the ones where all the local system owns all of the problem but this practice is all too rare.

The Department, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice. The result is unacceptable variation in local performance.

While we recognise there are significant pressures on adult social care and NHS funding, NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement. Patients and the NHS have a right to expect better. 

Further information

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