The United Kingdom is currently grappling with a profound crisis in its adult social care system, and one significant aspect contributing to this challenge is the issue of delayed discharges from hospitals. Delayed discharges can occur when patients are deemed medically fit to leave hospital but unfortunately face delays in finding suitable and appropriate social care arrangements. This predicament not only puts immense pressure on our healthcare system but also has far-reaching consequences for the affected individuals, including an increased risk of mortality. The number of Regulation 28 reports made by Coroners is likely to rise as this crisis deepens, bringing attention to the acute need for comprehensive reform.
The Scale of the Crisis:
Statistics reveal the severity of the delayed discharge issue in the UK. According to discharge delay data from NHS England, in December 2022, out of 21,685 patients who no longer met the criteria to reside in hospital, 13,440 (62%) were still occupying hospital beds. In December 2023, this figure was slightly lower, with 12,203 beds being occupied by patients deemed medically fit for discharge. However, the total figure of patients who no longer met the criteria to reside (19,270) represented a 1% increase from the previous year to 63%. Ultimately, this means that thousands of individuals, often elderly and vulnerable, are left in hospital beds despite being medically cleared for discharge, and the current statistics are not indicative of any improvement.
The Impact on Patient Well-being and Mortality Rates
Delayed hospital discharges have a direct and detrimental impact on the well-being of patients. Prolonged stays in hospital environments, which may not be conducive to recovery, can lead to an increased risk of hospital-acquired infections, loss of independence, and a decline in mental health. Moreover, the lack of appropriate social care arrangements can leave patients feeling unsupported and isolated, exacerbating their overall health outcomes. Physical and mental decline can make it more challenging for an individual to regain their independence, consequently increasing their need for social care, which exacerbates pressures to find suitable care placements. One of the most alarming consequences of delayed discharges is the potential increase in mortality rates.
Regulation 28 Reports:
As the number of deaths related to delayed discharges rises, the frequency of Regulation 28 reports related to this issue is expected to follow suit.
Regulation 28 of the Coroner’s (Investigations) Regulations 2013 requires coroners to issue reports to prevent future deaths in cases where they believe action should be taken to prevent a recurrence of similar incidents. These reports play a crucial role in highlighting systemic failures and urging those with the power to take action to implement necessary change. Recently, a Manchester South Coroner wrote to the Department of Health and Social Care, warning of the risk of future deaths unless action is taken to address concerns raised during the inquest of an NHS patient who contracted sepsis. The Coroner advised in her Regulation 28 letter, that residual staffing shortages in the district nursing service will not be resolved without a change of approach nationally, and until action is taken there is a risk of future deaths.
According to NHS Digital, district nurse numbers have almost halved in 15 years. In September 2009, there were 7,643 district nurses compared to just 4,208 in January 2023. Pressure on social care services has also increased as a result of underinvestment and staff shortages, with a 3% decrease in filled posts in social care in England since 2021, and vacancies increasing by 52% in the same period. These pressures are undoubtedly of huge significance in delays in pre-discharge assessments and securing placements for patients who require them.
A comprehensive approach is required to address the root causes of the crisis, including issues such as funding, workforce shortages, and the integration of health and social care services. Moreover, a focus on preventative measures, such as community-based care and support services, is essential to alleviate the strain on hospitals and improve overall patient outcomes. This will serve to improve the integration between health and social care services which is currently causing bottlenecks in discharge processes.
The Government’s Response:
The Government has introduced measures and implemented funding to try to alleviate the pressures health and social care services are under in relation to discharge from hospital. In its September 2022 Plan for Patients, a £500 million Adult Social Care discharge fund was announced ‘to support discharge from hospital into the community and bolster the social care workforce, to free up beds for patients who need them.’ However, the Nuffield Trust, a health think tank advised that it is ‘unlikely that a relatively small temporary fund will magically fix the myriad factors underlying the problem.’ There were also criticisms associated with the length of time it took for funding to be received by the ICBs and Local Authorities.
In the 2022 Autumn Statement, the Government announced £600 million of new grant funding in 2023/24 and £1 billion in 2024/25 to assist with getting people out of hospital and into care settings. It is hoped that this funding will increase NHS capacity in hospitals to improve patient flow; identify and tackle process issues which are contributors to the current delays and expand the range of NHS and social care services that are available to offer support to patients beyond their stay in hospital. Time will tell as to the efficiency of these measures in improving the current discharge delays and reducing the pressure experienced by health and social care providers.
Conclusion:
The UK’s adult social care crisis, particularly concerning delayed discharges from hospitals, poses a significant threat to the well-being of vulnerable individuals. The escalating mortality rates and anticipated increase in Regulation 28 reports highlight the pressing need for systemic reforms.
In a House of Commons debate on 23 January 2024, Helen Whately, the Minister of State for the Department of Health, and Social Care advised the Department is working to join up health and social care and care hubs, helping people to recover at home with more than 10,000 new virtual ward beds and investing in social care. Ms Whately reported that last month, delayed discharges were down 9% compared with the end of December 2023, despite almost 1,000 extra urgent admissions to hospitals everyday in December. However, as explored above, it would seem that when this data is considered in light of the number of patients in hospital who no longer meet the criteria to reside, the picture is not so positive.
This article was authored by Laura Clarke.
For further information, please contact:
Emma Stockwell, Partner, Hill Dickinson
emma.stockwell@hilldickinson.com
