NHS shells out £820m per year on older patients bed-blocking, says NAO report


Delays in discharging older patients from hospital when they no longer need care is costing the NHS in England more than £800 million a year, a new report has concluded.

The health service is shelling out £820 million every year on so-called bed-blocking - which occurs when patients are medically fit to leave but care has not yet been organised to help them outside of hospital, according to a new report by the National Audit Office (NAO).

Older people are cared for in hospital by the NHS, but once discharged some may need short or long-term support from their local authority or community health services.

This can include being helped to live at home or being put into a care home.

A recent report by the King's Fund highlighted that at the end of March 2016 more than 5,700 patients were delayed in hospitals, an increase of 15% over the year and the highest number since 2008.

The authors of the latest report estimate that around 85% of delayed transfers of care are of patients aged 65 or older.

The official number of reported hospital bed "days lost" due to delayed transfers of care - the total amount of days patients around the country are in hospital beds unnecessarily - was 1.15 million in 2015, a "substantial" 31% jump from 2013, the NAO said.

But the authors called into question the official data and suggest the figure may actually be much larger. They estimated that it could be as high as 2.7 million "bed days" a year.

The report said the main drivers for this rise are people waiting longer for home care packages or nursing home places. The authors point out that local authority spending on adult social care has reduced by 10% in real terms since 2009-10.

Difficulties in staffing problems across the health and care sector are another cause of delays, they said. 

Vacancy rates for nursing and home care staff were up to 14-15% in some regions, and less than half of hospitals felt they had sufficient staff trained in the care of older patients

While hospitals are financially incentivised to reduce discharge delays, there is no similar incentive for community health and local authorities to speed up receiving patients discharged from hospital, they added.

The NAO called on the Department of Health, NHS England and NHS Improvement to set out how they will break the trend of rising delays against the challenge of the growing number of older people in the population.

Amyas Morse, head of the National Audit Office, 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."

Commenting on the report, Meg Hillier, chairwoman of the Public Accounts Committee, said: "Older people staying in hospital when they no longer need to is bad for their health and bad for the NHS, unnecessarily costing it £820 million a year.

"Too often this descends into a blame game. For the sake of older patients and the financial sustainability of the NHS, both hospitals and local social services have to get their act together to discharge people more quickly when it is safe to do so.

"If this is not sorted all the agencies face an unsustainable situation of rising costs, rising demand for care, and funding cuts."

A Department of Health spokesman said: "Elderly patients should never be stuck in hospital unnecessarily and we are determined to make health and social care more integrated. As well as funding the NHS's own plan for the future with £10 billion, we are giving local authorities access to up to £3.5 billion extra for adult social care by 2019/20."

Parliamentary and Health Service Ombudsman Julie Mellor added: "Health and social care leaders must look at the discharge process as a whole and uncover why ten years of guidance to prevent unsafe discharge is not being followed, causing misery and distress for patients, families and carers."