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Poor discharge of elderly people costs NHS £820m

Current management by health and social care system is poor value for money, says NAO

Louise Prime

Thursday, 26 May 2016

Patients and taxpayers are getting poor value from the health and social care systems’ current management of hospital discharge for older patients, the National Audit Office declared this morning. The latest NAO report found that keeping older people in hospital for longer than they need acute care not only negatively affects their health, but it also has a gross cost to the NHS of an estimated £820m a year. In response, the National Institute for Health and Care Excellence called for older patients to be offered early supported discharge from hospital to more appropriate community or care home settings, in accordance with its own draft quality standard.

The NAO said when older people stay in hospital longer than clinically necessary, they quickly lose mobility as well as the ability to manage everyday tasks; and it also puts extra, and avoidable, pressure on NHS finances and local government. Because of the rising demand for admissions resulting from an ageing population, the NAO called for a “step change” in performance to resolve the problem.

It reported today that official figures for delayed transfers of care over the past two years – which already show a rise of 270,000 days (31%) to 1.15 million days – are in fact a huge underestimate because they don’t include all patients who no longer need acute treatment, just those whom doctors and others deem ready for discharge. NAO estimated that the true number could be up to 2.7 million days.

NAO head Amyas Morse said: “The number of delayed transfers has been increasing at an alarming rate but does not capture the true extent of older people who should not be in hospital. While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there. Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.”

The report’s authors said the correct balance must be found between moving patients out of hospital before they are clinically ready, and minimising delays. But they pointed out that following the NICE guidance, which says that people should leave hospital as soon as they are clinically ready, could lead to additional costs of about £180m for other parts of the social care system – which has to be set against the potential £820m savings for the acute sector.

The NAO found that one of the reasons for delayed discharge is poor workforce capacity in health and social care organisations, as providers and commissioners reported difficulty with recruitment and retention of staff; there are nursing and home care staff vacancy rates of 14-15% in some areas. But it said that a lack of financial incentives for community health and local authorities to speed up their receipt of discharged patients also contributed to the problem.

A spokesperson from NICE commented: “Whilst we understand the pressures facing our health and social care system, our guidance aims to improve the situation that some older patients are finding themselves in. Moving people to more appropriate community or care home settings will help reduce the cost burden on the NHS for hospital bed days, as well as ensure that a patient’s wellbeing is being looked after – particularly if they are older and more vulnerable.”

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