College’s deep concern over Scottish care home closures ahead of winter

The Royal College of Physicians of Edinburgh (“the College”) is expressing deep concern over the warning from Scottish Care that at least one care home in Scotland is closing down each week, amid fears that this rate of closure may escalate.

The reduction in care home capacity will intensify the problem of delayed discharge from hospitals, which impacts greatly on patient flow across the entire acute hospital system, especially in winter when demand for NHS services is even higher. Delayed discharge levels remain historically high: in the year ending 31 March 2023, there were 661,705 days spent in hospital by people whose discharge was delayed, the worst annual figure reported. These delays not only affect patient flow through our hospitals but are also detrimental to the welfare of patients and their families.

The College is urging the Scottish Government to consider all possible actions to ensure the care home sector is able to operate on a sustainable basis.

Commenting Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

The College is deeply concerned that care homes in Scotland are closing at the rate of one every week. Care homes not only provide long term care for older people but often act as a bridge from hospital to home.

A major cause of the flow difficulties experienced in acute care in recent years has been “exit block” – the difficulty in supporting patients back to their homes after hospitalisation. Capacity in care homes is already stretched and any further reduction  will not only have an impact on the NHS Scotland’s ability to provide safe and effective care in its acute wards, but will impact on the dignity and welfare of those patients who are delayed and have to wait inappropriately for weeks or months in hospital wards.

The impact of a decline in care home capacity is felt across the  whole system – contributing to longer waits in emergency medicine and a decline in bed availability for elective surgery in hospital wards.

Capacity issues are year round in the Scottish NHS at this time – the winter months only see the situation worsen, hence our warning now, that care home capacity must be protected in the coming months. 

We urge the Scottish Government and local government stakeholders, as a matter of urgency, to get round the table with the independent care sector and explore all options to support it and help make it sustainable, not least in terms of tackling its very severe workforce challenges. We need to have a successful care home sector for both the people who require places within it and for the effective functioning of our NHS as a whole.