Delays in hospital discharge continue to impact on A&E performance.

The Royal College of Physicians of Edinburgh (“the College”) has again expressed its concern about the delays in patient flow in Scotland’s hospitals and their impact on A&E performance. It comes after data revealed by the Royal College of Emergency Medicine (RCEM) indicated that the number of people in Scotland who waited 24 hours or more in A&E in the first half of this year was more than 250 times higher than in 2019.

In the financial year ending 31 March 2023, there were 661,705 days spent in hospital by people whose discharge was delayed, the highest annual figure reported. In comparison, in 2018/19 there were 521,772 bed days occupied by people delayed in their discharge. As such, the most recent annual figures have seen an increase of almost 140,000 bed days since then, a rise of 26.8%.  Monthly figures for the number of patients whose discharge was delayed in hospitals in Scotland show that levels remain high with over 1800 patients delayed in August this year, the latest month for which data has been published by Public Health Scotland. Again, in comparison in August 2018 1,458  patients were delayed so August 2023’s figures represent an increase of 350 patients or over 24%.

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

We share the RCEM’s deep concern about the intense pressures on our A&E departments, not least as we approach the winter period, and the excessive waits that are being faced by far too many patients, which have increased substantially compared to pre-pandemic levels.

We consider that an important factor impacting on A&E department capacity is patient flow within our hospitals, with high levels of discharge delays meaning doctors are struggling to move patients from A&E to in-patient acute wards. In short, one of the reasons we can’t get people into hospital as quickly as needed is that we can’t get them home quickly. We understand the focus on patients arriving at A&E departments- the hospital ‘front door’- but we also need to pay real attention to getting patients who are medically fit to leave out of the hospital- the “back door” of hospitals.

Even if patient waiting times in A&E were much better than they currently are, the situation with delays in discharge is highly undesirable in and of itself. Most patients – and their families – want to get home as soon as they are able, and not spend unnecessary time in a hospital environment.

Delays in discharge do not only affect patient flow through our hospitals, but they are also detrimental to the welfare of patients and their families. It is essential that we make progress in reducing delayed discharges for the sake of patients, families, carers and services.

The Royal College of Physicians of Edinburgh urges the Scottish Government to redouble efforts to support patients to return home after hospitalisation. This means valuing the social care workforce more than has been the case, attracting more people to work in social care, and providing better support for the many family and friends who act as informal carers in the community. It also means looking at reforms to adults with incapacity procedures to allow patients to move from acute wards into social care facilities while issues like guardianship are addressed.

Most delays in discharge are experienced by older people, especially those living with frailty and dementia. Alongside the British Geriatrics Society, we are backing calls for the establishment of an Older People’s Commissioner in both England and Scotland to advocate for the rights of all older people.