Letter to Scotland's First Minister on delayed discharges

Dear Mr Swinney,

Ahead of the Scottish budget on 4 December, I am writing to ask that your government addresses the urgent issue of delayed discharges in our healthcare system and to request additional funding to help mitigate this challenge. 

We note that 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. We further note the pressures on the care home sector as revealed by the Public Health Scotland annual care home census. The census revealed that 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. These data are of major concern to those working in health and social care. 

As you may be aware, delayed discharges not only impact the efficiency of our healthcare services but also affect the wellbeing of patients and their families. Delayed discharges occur when patients who are medically fit to leave the hospital are unable to do so due to a lack of appropriate care arrangements in the community. This situation results in bed shortages, increased pressure on hospital staff, and significant financial costs. More importantly, it can negatively affect the health and quality of life of patients who are left in an institutional setting longer than necessary.

To effectively address this issue, The Royal College of Physicians of Edinburgh (the “College”) proposes the following measures which will require financial support from the Scottish Government:

• 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. Great attention must be given to the terms and conditions of the social care workforce both nationally, but also in island and rural areas where staff are harder to attract, resulting in the need to deploy expensive agency staff to care homes in these communities. 
• 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. Family carers are delivering care under challenging circumstances as according to the Carers UK State of Caring 2024 survey, 61% of unpaid carers are worried about living costs and managing in the future, and over a third (35%) do not feel confident they will be able to manage financially over the next 12 months. 
• 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. While we welcome the expansion of Hospital at Home, the College requests that these services operate with safe staffing levels and that safety and quality outcomes are monitored to the same level as occurs in other settings. 
• 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.

By addressing these areas, we can significantly reduce the occurrence of delayed discharges, leading to a more efficient and patient-centred healthcare system. I urge the Scottish Government to consider this request for additional funding to tackle this pressing issue.

Thank you for your attention to this matter. I look forward to your positive response and to working together to improve our healthcare system.

Kind regards,

Professor Andrew Elder, President