As many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go.
Guardian analysis of official data shows that on average 13,600 beds across NHS England are occupied every day with patients who doctors say are medically fit to go home or to a care home, equivalent to one in seven beds in acute hospitals in October.
However, that rose to more than one in five at 35 of England’s 121 acute hospital trusts, and to almost one in three at two trusts – North Bristol and Wrightington, Wigan and Leigh NHS trust.
Previous work by the Nuffield Trust has revealed the majority of delayed discharges are down to a lack of social care, be that social care in patients’ own homes or placements in a care home, or NHS-funded aftercare.
The situation has deteriorated sharply in 35 hospital trusts, including Epsom and St Helier university hospitals in London – where delayed discharges have risen from 6% in April to 20% in October – and Liverpool university hospitals, which jumped from 10% to 23% within the same period.
“There’s certainly a sense of this getting worse,” said Miriam Deakin, the director of policy and strategy at NHS Providers.
The figures come as the NHS is gearing up for what is expected to be one of the toughest winters yet, with flu, Covid and record NHS staff vacancies putting pressure on the system. NHS England announced last month it was setting up system control centres or “war rooms” to cope.
Earlier this month, Sarah McClinton, the president of the Association of Directors of Adult Social Services, said the state of social care in England had never been so bad, with half a million people waiting for help.
“The shocking situation is that we have more people requesting help from councils, more older and disabled with complex needs, yet social care capacity has reduced and we have 50,000 fewer paid carers,” she said.
Rishi Sunak is reportedly considering delaying changes to social care announced by his predecessor, Boris Johnson, that would have put an £86,000 cap on the amount people have to pay for care. It is thought that delaying the policy would save the government £1bn in the first year, rising to £3bn if it were scrapped altogether.
The impact of delayed discharges on new patients has long been evident, with A&E departments heavily congested and ambulances queueing outside hospitals unable to transfer patients and get back on the road.
But the effect on the patients stuck in hospital can also be profound. “Your muscular ability can deteriorate in a hospital bed – and that’s quite rapid for older people actually – your mental health can suffer, you can lose independence really quickly,” said Deakin.
Speaking to the Guardian, one patient described becoming depressed and losing hope after being told he was 26th on a waiting list for a rehabilitation placement, while another person described how his mother sustained a hip fracture and serious cuts to her shin in accidents that occurred while waiting to be discharged.
Prof David Strain of the British Medical Association and the University of Exeter medical school said those unable to leave hospital because they are waiting for social care are a vulnerable population. “Very often they will have a physical disability, or they’ll have early or even profound dementia,” he said.
Strain added that moving such patients, for example to a ward of people awaiting discharge, can reignite delirium, meaning patients are instead kept in the same hospital bed.
“That means that they’re often sat in acute medical wards, with patients coming in, very unwell … and I mean during Covid times, people who are literally coming in and dying in beds next to them,” said Strain.
Strain said lengthy delays could mean patients begin to lose the ability to look after themselves, even when it comes to simple tasks such as choosing their clothes.
“The weeks that people end up waiting for the right care to be available further institutionalises them, and it makes any chance of going back to their own home almost impossible,” he said.
Patients can also acquire infections while stuck in hospital, and suffer falls due to the unfamiliar environment and growing frailty.
Strain said the delays in discharge could range from about a week to a couple of months. “It’s a major concern for both patients who are the victims of this, and also other patients that can’t get into hospital beds that need [them],” said Strain.
Prof Martin Green, the chief executive of Care England, said the personal impact on people was beyond measure.
“What we see are [that] late discharges often result in people having far more dependency than they would have done if they’d been discharged appropriately,” he said, adding that this can be traumatic for the individual themselves.
A major problem affecting social care is lack of funding, he said. “Some local authorities are paying [care workers] £6 an hour for 24-hour care, three meals a day, supporting people with loads of co-morbidities, having to do all the personal care stuff,” said Green. “How is that possible?”
Deakin agreed. “Not enough money is flowing from government through local authorities to pay for social care. And that impacts on the wages that care providers can then offer to their staff,” she said.
A Department of Health and Social Care spokesperson said: “We are investing £500m of extra funding to speed up the safe discharge of patients from hospital and recruit and retain more care workers to support people who no longer need to be in hospital. The NHS is also creating the equivalent of 7,000 more beds this winter – enabling hospitals to treat patients more quickly, including by using remote monitoring to provide care at home or in the community.
“Alongside this, the NHS discharge taskforce has been working directly with the NHS trusts facing the greatest discharge delays to ensure best practice is being implemented.”
The Guardian recently revealed how hospitals and care services have not received a single penny of the £500m funding to speed up discharge of patients promised by the government.
Ministers said they were injecting the cash into the health and social care system on 22 September. However, the Guardian has established that none of the funding has materialised.
• This article was amended on 14 November 2022 to include a reference to post-discharge services funded by the NHS, which can also contribute to delayed discharges.
