Huge alarm at record levels of delayed discharge

Huge alarm at record levels of delayed discharge

The Royal College of Physicians of Edinburgh (“ the College”) has expressed “huge alarm” at the levels of delayed discharge in Scotland’s hospitals after the latest figures published yesterday by Public Health Scotland (PHS) showed them reaching a record in August. At the August 2024 census, there were 2,009 people delayed in Scotland’s hospitals. 62,003 days were spent in hospital by people whose discharge was delayed in August, an 11% increase on the number of delayed days in August 2023.

The College has also highlighted the pressures on the care home sector as revealed by the annual care home census, also published yesterday by PHS. The census revealed there were 1,020 care homes for adults and 40,079 registered places at 31 march 2024 – 18% and 6% less, respectively, compared with 31 March 2014.

The College’s concerns have been backed up by The Royal College of Emergency Medicine (RCEM) Scotland and Scottish Care.

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

As we move closer to another Scottish winter, when pressure on access to and flow through our acute hospital beds will rise substantially, the latest figures on delayed discharges are a source of huge alarm.  

We are doing a great disservice to those people whose discharge from hospital is delayed, and a further disservice to those who will have to wait to get into hospital beds that cannot be freed for their use. If we can’t get people out of our hospitals we will struggle to get others in.

We again call for appropriate levels of funding to maximise availability of both “interim” and long term care home placement and urgent review of those parts of the adults with incapacity legislation that prevent some people from moving from health facilities to social care facilities in a timely manner. We have previously highlighted the need to value – in the broadest sense of that word – the many paid and informal carers who support older people to go on living in their own homes and those who support older people living in residential and nursing facilities. However, without a coherent strategy to support family carers and recruit, retain and adequately remunerate the care workforce, we predict that delayed discharges will continue to rise.

It is also difficult not to link the rising numbers of delayed discharges with the falling number of care home places evidenced in PHS’ report. The combined care capacity across the health and social sectors is critical to good flow and timely treatment – the rising numbers of delayed discharges tell us that whole system capacity is inadequate.

Dr John-Paul Loughrey, Vice President (Scotland) RCEM, said:

This data reveals the scale of the issue in black and white - thousands of people every day remaining in hospital when there was no medical requirement for them to be there.

While the beds they remain in are desperately needed by other people, stuck in Emergency Departments, often in corridors waiting extreme amounts of time to be admitted.

The system only works when patients can be moved into wards when they need to be, and then out of them again when they are well enough.

In order for people to get back to their homes, they need adequate social care support.

Until this is provided, and is available at a scale matching the need, we will continue to see our NHS in paralysis with A&Es dangerously overcrowded, and ambulances queued up outside.

We need a functioning health AND social care system, so the people of Scotland receive the care and support they need when and where they need it.

Dr Donald Macaskill, CEO of Scottish Care, said:

The story behind the statistics is more complex and more concerning than even the data might suggest. 

At a time when there is greater demand than ever before not least as evident in delayed discharge, what we are witnessing is not only a reduction in bed capacity but also a restriction of that availability because care homes cannot afford to open up availability because the resource offered is inadequate.

Further the lack of investment over a decade has resulted in a tired and dated physical environment in need of urgent attention but at a time when external funding is scarce and public resourcing inadequate. 

In addition, the closure of care homes is not uniform across the country but is especially where it has proven impossible to recruit a workforce with the resultant use of agency staff making it very expensive to staff care homes. This is especially in rural and remote areas.