Delayed discharges going down but challenges remain

An Audit Scotland report published today highlights that solving the problem of delayed discharges needs action across all parts of the health and community care system. Although the number of patients delayed in hospital is steadily falling, a growing older population means that further action is needed to sustain this progress. This includes:

• Preventing unnecessary admissions to hospital;
• Speeding up discharge planning arrangements in hospital; and
• Ensuring that older people have the right health and social care services to support them in the community.

Most patients are discharged promptly from Scottish hospitals, but some patients may have to stay in hospital longer than necessary if any ongoing care that they need is not arranged in time. This is often called a ‘delayed discharge’. This can be upsetting for patients and their families, and may also lead to cancelled operations and longer waits for other patients who need hospital treatment.

In an innovative project, Audit Scotland has worked with the NHS board and three councils that make up the Tayside Partnership to share an understanding of how its local care system works; identify key factors that lead to delays in Tayside; and develop a computerised model to help Tayside test out strategies to reduce delayed discharges. While the Tayside model cannot simply be transferred and used by other partnerships, they may benefit from adopting a whole systems approach to improve their understanding of a complex system.

Auditor General, Robert Black, said:

“It’s important to acknowledge the good work that’s being done by local health and council partnerships, aided by the Scottish Executive, to reduce the numbers of patients who have to stay in hospital longer than they need to. But it’s a very complex issue to try to resolve, and needs an in-depth understanding of how the local health and social care systems work together. Audit Scotland has tried to get beneath some of this complexity by working with the Tayside Partnership to get a better, shared understanding of its local care system, and identify what action might reduce delays from hospital.”

Chair of the Accounts Commission, Alastair MacNish, said:

“It is good news that the number of people delayed in hospital is reducing. But we are still seeing that about three in every four delayed patients remain in hospital because they are waiting for community care services to be put in place. Councils need to continue working with their local NHS partners to reduce these kinds of delays. ”

The key findings of the report were:

• The number of patients delayed in hospital has reduced over the past few years, although it remains a problem. The total number of people delayed in hospital has fallen by 40% from September 2000 to January 2005 (from 3,021 to 1,785).
• The Health Department has set a national target of a 20% annual reduction in delayed discharges in all 15 partnerships. But the way in which the target is set potentially penalises partnerships that perform well against their target as the best performers are set a more challenging target for the following year. This acts as a possible deterrent. A uniform national target also does not necessarily recognise the complexity involved in reducing delayed discharges, nor does it reflect local circumstances.
• Local partnerships use a range of initiatives to reduce delayed discharges in their areas. But these need better evaluation to assess their success and whether they deliver value for money.