College outlines key health asks ahead of Scottish budget

The College is calling on the Scottish Government to invest in measures to reduce “delayed discharges” ahead of the Scottish Budget statement on Wednesday 4 December.

This could help people leave hospital sooner and free up much-needed hospital beds, therefore reducing pressure on the hospital network.

Delayed discharges, sometimes referred to as “exit block” in the NHS, is the term used to describe medically fit people who are waiting too long to be discharged from hospital back home, or to a more appropriate care setting such as a care home. As such, many older people are affected by delayed discharges. 

At the September 2024 census, there were 1,951 people delayed in hospitals across Scotland. This equates to 59,033 days spent in hospital by people whose discharge was delayed – representing 9% increase on the number of delayed days in September 2023 (54,342).

This situation results in hospital bed shortages, increased pressure on hospital staff, and significant financial costs. More importantly, delayed discharges can negatively affect the health and quality of life of patients who are left in an “institutional” setting longer than is necessary.

In a letter to the First Minister, John Swinney MSP, the College has set out 4 measures which the Scottish Government could introduce to reduce delayed discharges:

• Increase community care capacity: Investing in community care services, including home care support and residential care facilities, can ensure that patients have appropriate care options available upon discharge. 

• Support for Family Caregivers: Providing financial support and training for family caregivers can enable more patients to be cared for at home, reducing the reliance on hospital or residential care. 

• Enhanced coordination between healthcare providers: Funding to improve the coordination between hospitals, social services, and community care providers can streamline the discharge process and reduce delays. 

• Investment in Technology: Implementing advanced technology systems to track patient progress and discharge planning can improve efficiency and communication between different care providers; however care is needed to ensure that the use of such technology does not widen health inequalities.

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

We have written to the First Minister about delayed discharges primarily because of the negative impact that unwanted and unwarranted hospital stays have on the physical and mental wellbeing of patients, particularly older people. 

However, it is also important to highlight that we can only address long waits in A&E and loss of elective surgical capacity in hospitals if we address the “back door” pinch points caused by discharge delays. Our hospitals will be unable to operate at their capacity until we improve this situation.

Ahead of the budget, we’re calling for investment to meaningfully reduce delayed discharges to ensure that people are receiving care in the most appropriate setting, to free up hospital beds, and to reduce pressure on the entire secondary care sector. 

In order to do this, the Scottish Government must increase care capacity in residential and domiciliary settings, take steps to improve coordination between healthcare providers, invest in the right technology, and increase support for family carers – who provide an enormous amount of care already, but without sufficient recognition.

If the Scottish Government is serious about creating a more efficient and patient-centred healthcare system, then delayed discharges must be dramatically reduced. 

This is not a new problem in Scotland – we would not tolerate such delays which affect many of our older people. The ageing of our population is a triumph and the lack of effective “social care” in Scotland risks turning that triumph into a disaster.

Amidst a wide range of possible funding targets in health and social care, we believe that funding for the social care of older people must be a top priority.