Delayed discharge from hospital – The best way to reduce them

What causes delayed discharge from hospitals?

‘Bed blocking’ is one of the main causes for delayed discharge from hospitals, but the term ‘bed blocking’ often carries negative connotations suggesting that patients are to blame for occupying a hospital bed longer than they technically need to. The reality is that bed blocking has become part of our nomenclature.

The term bed blocking refers to the difficulty in discharging patients due to limited care and support being available in a patient’s local area. The limited amount of care available creates delays in the discharge process, as there is nowhere deemed safe for a patient to be discharged to. This in turn leads to increased pressure on hospitals beds and beds in care homes, where finding space for new arrivals becomes increasingly difficult.

One of the main reasons why local authorities are limited in the care and support they can offer in their discharge care packages is because our biggest provider of adult social care services (the private sector) is currently facing a staffing crisis; both the recruitment and retention of staff. This is because the health and social care sector are dealing with high cases of staff burnout; brought about due to tough demands, long hours, and strain from the Covid-19 pandemic.

The Local Government Association (LGA) have stated that 71% of councils are struggling to recruit adult social care workers and have called on the government to deliver a long-term care workforce strategy to tackle the issues of staff recruitment, retention, and pay.

Skills for Care, in their report on the state of the adult social care sector, stated that as of May 2022 the vacancy rate in local authority adult social services was 10.2%. The LGA's 2022 Public Health Annual Report published with the Association of Directors of Public Health (ADPH) stated that more than half say their public health services are being disrupted due to staff shortages.

What is clear is that staff shortages are due to funding pressures. With limited budgets, that are needing to be stretched further and further each year, it is becoming increasingly difficult to make long-term plans for staffing and development. Without long term funding councils struggle to confidently make plans to develop or recruit the workforce they need, in order to deliver the best quality of care possible.

There is optimisation needed in the discharge process though, which could mitigate some of the issues with bed blocking and lessen the impact of staff shortages. In many cases of hospital discharge delays the slower speed of discharge is due to outdated manual processes. These are long-winded and an inefficient use of human resources when healthcare software can do the same tasks in a fraction of the time. Not only is this frustrating for the patient and the hospital, but it can also lead to individuals being placed in unsuited care settings, patients being left until a placement becomes available, or even a council onboarding an incompliant provider so patients are at least in a care setting – even if that setting is inappropriate and fails to meet the local authorities’ responsibilities under the Care Act.

What are the impacts of delayed hospital discharges?

Delayed hospital discharge impacts three different groups in a variety of ways:

1. Patients and their loved ones
2. Hospitals
3. Local Authorities
   
   

1. Patients & loved ones

• Patients are left in hospital longer than they need to be
• Increased risk of stress and uncertainty about the next steps of the patient journey
• Decreased morale and mood
• Diminished care outcomes
  
  

2. Hospitals

• Risk of running out of hospital beds and overflow beds
• Bad for patient flow
• Increased pressure on staff to meet targets
• Increases hospital and health system costs
• Reputational damage
• Difficulty finding space for new arrivals
  
  

3. Local Authorities

• Increased pressure to find appropriate care and continuing healthcare placements efficiently and quickly
• Stretches budget and capacity
• Increased risk of not having enough resources to meet the demand
• Risk of losing data or information from long outdated processes leading to reputational damage and significant fines
• Risk of providing poor quality care which does not meet the regulatory requirements under the Care Act

What is the cost of delayed discharge from hospitals?

It’s estimated that delayed discharge procedures cost the NHS £900 million per year. This was a figure declared prior to the pandemic and the argument even then was that the figure could be higher, so the expectation is that post-Covid this will have broken the £1 billion mark – especially considering that ambulance handover times hit their highest in 2023, and over 14,000 patients medically fit in hospitals were not discharged.

The cost of looking for alternative settings, paying extra staff to meet the demand, including locum and relief staff all adds extra financial strain onto the NHS. The delayed discharged process also adds financial pressure onto local authorities. This in turn, stretches their limiting budgets further exacerbating the challenges they have already.

How is the government proposing to tackle the hospital discharge delay?

In order to tackle the delays in hospital discharges, the UK government announced that £250 million of funding would be given to speed up hospital discharges.

The funding was to buy short-term placements in community settings, including care homes, to fund stays of up to 4 weeks of extra care per patient, with an end date of January 2024.

£200 million of the funding was given to local authorities to ‘bolster’ social care workforces to increase their capacity so they take on more patients.

An additional £50 million of capital funding was given short-term to upgrade and expand hospital discharge lounges, ambulance hubs, and facilities for patients about to be discharged to tackle queues of paramedics waiting to handover patients.

Local authorities were told they could spend this money on initiatives that would have the greatest impact in their area on reducing discharge delays.

In order for this to be successful, the government encouraged local authorities and integrated care boards (ICBS) to work together to agree on their spending across their regions so more tailored solutions that benefit both parties can be introduced to speed up discharge processes in their local area.

The King’s Fund published a consultation report on hospital discharge funds in November 2023 which spoke with key stakeholders about their experience. With a general election expected in 2024 though, it is unclear if the incumbent government will renew the scheme for 2024/25.

What has the reaction been to the government’s proposal in tackling the hospital discharge delays?

Warnings about adult social care requiring more funding have been issued for some time now. ADASS warned in July 2022 how this would be necessary so it could have a significant impact on the pressures for the winters to come.

There have been many concerns that the this committed funding is too heavily reliant on care homes, and that in fact the funding should go towards making home care packages in a hospital discharge the priority. ADASS argues that defaulting to discharging patients to care homes runs the risks of individuals being inappropriately placed, and that patients will end up staying in residential homes indefinitely.

ADASS are not the only ones to voice this concern. David Fothergill, the community wellbeing board chairman for the LGA, has also said that this crisis has been caused due to under-funding from across the last decade and that more long term methods in easing pressure needs to be seen as an essential  task.

There are also concerns that with about 500,000 people awaiting social care needs assessment or care packages, focusing this extra funding on discharge processes could neglect people’s needs in the community and increase the risk of being self-defeating.

The Department of Health and Social Care however believes it will support thousands of medically fit patients to be discharged. If successful, it is also deemed to reduce pressure on A&Es and speed up ambulance handovers by allowing patients to be admitted to wards from emergency departments quicker.

The Health Foundation argues that often when extra short-term funding like this comes into play there often isn’t enough time for local authorities to utilise the funding strategically so often local authorities do not see the benefits they could see.

A UK Government survey in 2021 on workforce capacity fund for adult social care found that 55 out of 59 local authorities surveyed found the timeframe to use the workforce capacity funding in 2021 insufficient.

These mixed reactions show that despite different providers and stakeholders having different opinions on the discharge fund, what local authorities need is more time. This isn’t something the fund offers though, and local authorities need to seek alternative ways to be better prepared for future demand; to develop a more strategic approach to reduce hospital discharge delays.

Following the uncertainties of future funding, in January 2024 it was announced an additional £500 million in social care funding. The aim of this funding is to encourage local authorities to use this funding to drive innovation and increase performance. Through digitally transforming their social care services more medically fit patients can be discharged from hospital sooner back to their own homes with the appropriate social care they need to continue to recover. This, in turn, allows local authorities to deliver stronger proactive care that is catered to every individual and adapt as needs change by storing all information in one centralised place.

Discover our local authority software today to see how we can help digitally transform your services to improve quality, drive innovation, and most importantly reduce discharge delays and dependency on residential care homes.

How to improve the discharge process in hospitals

For local authorities to be in the best place to reduce hospital discharge delays, the first thing they must address is what are the main issues causing the delays in their community. It is crucial for local authorities to set targets and be strategic in their approach and work collaboratively with nearby local authorities to ensure no patient goes without the care they need, but until those issues are highlighted the next steps are more than likely to be unsuccessful.

Improving the discharge process in hospital will have a domino effect on the problems associated with the delays. One of the best ways to reduce hospital discharge delays is in investing in different technological solutions and digital tools which best suit your council’s needs.

There is a wide range of technology which can help local authorities achieve their goals in reducing discharge delays including:

1. Maintaining patient’s independence
2. Mitigating risks and improving the quality of care
3. Improving future forecasting
4. Having a better strategic approach
5. Improving the patient experience

1. Maintaining patient's independence

There are many different strategies councils and local authorities can follow, but the biggest concern is to follow a home-first principle. This will ensure that where possible when a patient is discharged they can remain independent and healthy in their own home.

Investing in technology-enabled care is just one example of supporting this. Technology enabled-care and digital telecare solutions provide an eco-system of solutions which offers both sustainable and preventative care.

At The Access TEC we offer more than just a digital alarm system. We combine traditional reactive alarm functionality with proactive digital monitoring so daily activities of life can be monitored and alerts can be sent out to both reassure and alert loved ones and care providers when needed.

Both local authorities and end-users can benefit from using digital telecare as our unobtrusive monitoring ensures that regardless of where a patient is discharged to they can remain independent for as long as possible, as long as it is deemed safe to do so.

One of our customers, Airtel Vodafone, worked with the Government of Jersey to encourage a mass roll-out of technology-enabled care across Jersey and found that through using our digital telecare and working collaboratively, over 95% of self-funding users chose to switch to the new service.

We understand that interoperability is highly important in the health and social care sector to help local authorities deliver better joined-up person-centred care. Our digital telecare helps address this gap in the health and social care market to help individuals stay independent for longer, reassure their loved ones in what has been a stressful time, whilst helping reduce discharge delays.

Our latest integration with our care planning software helps ease the transition to returning home to not only reduce discharge delays but prevent readmissions. Care workers can have full visibility of the smart alerts and alarms set up in the Access Assure Hub in our care planning mobile app to have all the information needed in one place.

Here better proactive care is enabled as staff feel empowered to make better data-led decisions that put the individual at the centre of everything they do. Patients also feel more comfortable continuing with their recovery in the comforts of their own home with the reassurance that help will be there before something more critical happens to make recovery easier and avoid readmission.

2. Mitigate risks / improve care quality

One reason why patients are delayed in their hospital discharge is because the available care placements may not be safe for them.

Investing in technology that thoroughly checks, assesses, and flags risks with care providers is a way to reduce delays whilst still maintaining the rigorous assessments expected.

Using digital dashboards is a great way to track your provider markets and make note of which providers will suit the right patient after their discharge assessment. Having all this information on your provider markets in one place makes it easier to spot trends and potential risks so that they can be monitored across care type and location.

We go a step further at The Access Group and our Risk Profiler solution brings together all this information and offers a variety of sophisticated filtering options so risks can be monitored according to the patient’s needs as well as your local areas needs too. Here regulator checks can be managed to ensure no individual receiving care whether it is in a residential home or with domiciliary care is put at risk.

Our Social Care Landscape module also helps you assess key challenges across nearby local authorities as well as your own so you have everything you need to know about demand, spend activity, capacity, and risk altogether so contingency plans can be put in place so everyone receives the care they need.

Worcestershire County Council found through assessing spend activity across different client groups and services across the market, they have been able to gain valuable up-to-date insight in how placements costs compare locally, regionally, and nationally.

This in turn, helps to determine the best care placement possible in real-time efficiently to reduce discharge delays and ensure all individuals receive the best quality care to make improving patient outcomes a top priority.

3. Improve future forecasting

Being able to accurately estimate future demand is imperative for local authorities to commission the right capacity of care needed across the adult social care market including discharge care plans.

One way to do this is through investing in demand modelling technology, so both demand and capacity can be consistently delivered now and in the future without putting anyone at risk.

The benefits from using demand modelling technology include being able to make highly accurate predictions about future demand. This then reduces the element of surprise if a patient needs a particular care plan, as through demand modelling your local council will already have an accurate estimate of how many other individuals need a similar care plan.

We conduct this through combining statistical forecasting techniques with artificial intelligence to manage unexpected events more efficiently and predict areas of risks to ensure the right provisions are in place without going over budget.

Middlesbrough Council, for example, have found using demand modelling has improved how their data is analysed to their improve future planning. Now they have up to 99% accuracy in their future forecasts to  ensure they have the capacity to facilitate any discharge care plan that may arise.

Demand modelling helps reduce the discharge delay therefore, by helping local councils be prepared and commission the right levels of resources needed so they are no surprises or delays when a discharge care plan comes through.

4. Having a better strategic approach

For local authorities to get the most out of their awarded funding they need to be proactive and have strategic commissioning.

One of the most important things local authorities can do to is digitally transform their procurement processes. Moving from long, outdated manual or paper-based processes is one of the best ways to save time searching for appropriate care placements for patients.

Through digitising your procurement process for continuing healthcare, the number of manual tasks can be reduced and the whole process can be streamlined via a single system.

Digitising your procurement process gives you full visibility of the provider market, so patients can be placed with fully compliant providers that meet their specific needs and are available when you need them.

At Access Adam Care Commissioning, we list the providers in real-time according to your needs. This way the highest ranking provider will feature at the top of your rankings automatically.

Midlands Lancashire Commissioning Support Unit (MLCSU) has found through digitising their procurement process they have better access and control of their provider market to create more effective patient pathways to improve outcomes, at a better value for money.

One resident found they were able to place their family member into their preferred care home which matched their needs better than what they were first offered, saving themselves over £5000 per annum in the process.

Digitising your procurement processes therefore helps reduce discharge delays as our commissioning platform helps find you the best provider by saving time and automatically selecting providers that best meet your care needs.

5. Improving the patient experience

By achieving all of the above a local authority is naturally improving the patient experience, but it’s also important to include patients in the decision-making process.

This is known as patient engagement, and is a great way to better educate patients so that they have the confidence to manage their own health in a more effective way. Including people in their own health and care journey – especially when it comes to decision making – benefits a patient’s mental health and their willingness to engage with clinical support.

This leads back to better care quality too, as a willing patient is onboard with their own treatment plan or care proposals and engaging with the support provided.

This concludes our article on delayed discharge from hospital. We've reviewed the main causes of hospital discharge delays and the impacts that has on patients, their families, hospitals, and local authorities. We have also looked at how technology can support preventative approaches to health and care, and how it can help local authorities best prepare for patients care plans.

At The Access Group we have a wide variety of solutions to solve specific challenges faced by different services involved in the planning and delivery of health and social care, and a full ecosystem to help join up all these services.

Through encouraging collaborative working with other local authorities too we can ensure that resources are shared so that individuals already waiting to be assessed don’t get delayed further by the increase in demand from hospital discharges, and instead resources can be well managed across the market.

For more information on how technology can help reduce hospital discharge delays and improve patient outcomes discover our local government software today.

Contact us and see how we can help you reach your goals so you can deliver the best continuity of care possible to the residents in your local community.