UK. Discharge of older patients from NHS acute hospitals

Citation

(2003), "UK. Discharge of older patients from NHS acute hospitals", International Journal of Health Care Quality Assurance, Vol. 16 No. 4. https://doi.org/10.1108/ijhcqa.2003.06216dab.005

UK. Discharge of older patients from NHS acute hospitals

UK

Discharge of older patients from NHS acute hospitals

Keywords: Social care, Old age, Patient care

A report from the National Audit Office (NAO) says the Department of Health and other health and social care bodies are making good progress in ensuring that older people who have finished treatment in acute hospitals are discharged promptly. However, more needs to be done to meet the Government's target to end widespread delays in patient discharge by 2004. The shortage of places in care homes is the most significant constraint on meeting that target. Concern is also expressed about evidence of inconsistency in how acute trusts define "delayed discharge" and problems with the accurate collection of data about delayed discharges since April 2002.

In February Sir John Bourn, Head of the NAO, said: "Many tens of thousands of older people each year find themselves unable to leave hospital, even though their treatment has been completed. This significantly reduces their quality of life and undermines the ability of hospitals to treat more patients and meet testing targets.

"The Department of Health has made strides in the last 18 months to address this problem but the pressures on the health and social care systems are unrelenting. This is a classic case of the need for 'joined-up government' with the NHS, local authorities and private and voluntary sector care providers working together. The Department should ensure that it is doing everything it can to allow this to happen."

He reported to Parliament that hundreds of thousands of older people are successfully discharged from hospital each year, but on any given day more than 4,000 people over the age of 75 (8.9 per cent of older patients) remain there despite being declared fit to leave. The figure is an improvement on the previous year, but although the delay was short for many patients, 34 per cent of those affected were delayed for more than a month. There were a range of causes, including poor procedures within hospitals, inadequate co-operation between the health and social care sectors, and a lack of capacity in appropriate post-hospital care. Delays can have knock-on effects for others awaiting treatment and can significantly affect a patient's physical and mental well being.

Actions have already been taken to improve the situation. These include the distribution of £300 million of Building Care Capacity Grant to local authorities linked to targeted reductions in delays in hospitals in their area, and over £800 million by 2003-2004 within the NHS to develop intermediate care facilities. Further measures are being developed, and the Government recently introduced into Parliament a bill to create a system of reimbursement of hospitals for delays caused by social services departments.

The report says that improvements in different parts of the health and social care system were leading to real reductions in the levels of delayed discharge, but it identified the need for further work in three main areas.

First, although improvements to discharge planning have been made by many NHS Acute Trusts since the last NAO examination in 1999, more needs to be done. More Trusts should start discharge planning earlier, and more should undertake assessments of care pathways for older patients to identify potential obstacles to discharge. Awaiting nursing or residential placement is the main cause of delays (26 per cent) but the length of time to carry out needs assessments is the second largest cause of delay (17 per cent) and this is often the result of a continuing shortage of skilled therapists. A Single Assessment Process is to be introduced in 2004 and this is seen as crucial for improving patient flow.

Second, there are encouraging signs of improvement in co-operation between health and social care bodies, despite their separate histories, often incompatible administrative systems, and lack of common geographical boundaries, but there has been limited use of opportunities for integration of older people's services offered by the Health Act 1999 and limited progress made in establishing Care Trusts.

Third, although additional funding has allowed an expansion of support for older people in the community and residential care shortfalls in capacity remain. The number of care home places is falling, and private sector care providers cited poor commissioning practice, financial pressures and high property prices as reasons for this. Alternatives such as intensive home care, and intermediate care that can avoid the need for residential care, are being developed but progress is slow and there are significant variations in provision of intermediate care services that should be addressed. The report says that there is an urgent need for Primary Care Trusts and social services to develop a strategic overview of providers in their areas to address shortfalls in service provision, especially through better relationships with the independent sector.

Further information: the full report, Ensuring the Effective Discharge of Older Patients from NHS Acute Hospitals, can be accessed in pdf format from the NAO Web site at: http://www.nao.gov.uk/publications/nao_reports/index.htm#2002-2003