The latest crisis in healthcare has shone a light on the long-standing issue of delayed discharge, where a patient is medically fit to leave hospital but is unable to do so.
On any given day on average over 500 people are marooned in hospital, unable to leave in a timely fashion. This is a significant challenge, and one which harms patients, staff and the healthcare system. The human and economic costs are difficult to overstate.
At an individual level, unnecessary hospital stays are associated with deconditioning, muscle wastage, hospital acquired infections, anxiety, depression, loss of confidence and premature mortality.
Discharge delays are self-reinforcing: patients kept in hospital longer than necessary are at risk of increased frailty, which may lead to more complex needs, a loss of independence and ultimately longer hospital stays. Delays are also stressful for the family and friends of people stranded in hospital.
In terms of economic costs, hospital stays are considerably more expensive than providing care in the community.
While actual costs vary and depend on the complexity of needs, it has been estimated that the cost for one night’s stay in hospital equates to the cost of two weeks of domiciliary care.
At a basic level, delayed discharge wastes resources by accommodating patients who have recovered in beds that are designed for patients who are unwell. This reduces the productivity and efficiency of health delivery in the acute sector.
Understanding the of flow of patients through a health setting is a complex activity which is dependent on coordination both internally and externally.
Read more: Stormont must ‘accept the consequences’ of underfunding health, official warns
We know from existing research from other regions that some delays are down to hospitals’ own internal processes such as slow decision-making, the availability of discharge letters and prescriptions, the organisation of transport and lower discharge rates at weekends.
Other delays are directly related to pressures in the social care system, including a lack of home care packages, insufficient rehabilitation services, limited step down or interim care facilities and the inability to secure a suitable residential or nursing home placement.
While actual costs vary and depend on the complexity of needs, it has been estimated that the cost for one night stay in hospital equates to the cost of one month’s domiciliary care
Unnecessary stays in hospital represent a sub-optimal use of limited financial resources. Given the unrelenting calls for more money for health, ensuring existing funds are well spent should be a top priority.
How has the situation been allowed to get this bad? The crisis witnessed over this winter with growing numbers of patients delayed in hospital is just one manifestation of abject policy failure.
Hospitals have been left unable to discharge thousands of patients for want of strategic planning and economic modelling.
Read more: Health Minister: £8.4 billion and half of Northern Ireland’s government budget is not enough
The lack of action to address this is astounding. Given the imperative for greater productivity and efficiency in health and social care, one might assume that tackling stagnation of patient flow would be a key priority for the Department of Health.
Wrong. No comprehensive research on how much could be saved if people were not marooned in hospitals. No ideas about how to take advantage of our unique integrated health and social care system. No regularly published data on delayed discharge. No development and promotion of good practice.
What is to be done? For example, the establishment of a regional Delayed Discharge Unit could be a starting point to address some of the problems that have beleaguered the system for years.
The objectives of this unit could be to routinely publish detailed data on the numbers of delayed discharges by hospital; to specify the clinical specialities associated with delay and set out explanations; to use data to inform commissioning; to explore the possibility of procuring a regional discharge service; to identify good practice and ensure that it is embedded across all trusts; to commission extensive research to identify bottlenecks and pinch points; to facilitate informed decision-making and the development of evidence-based policy.
Next winter must be better. There is ample time to prepare, and there can be no excuse for patients and their families to suffer the same chaotic scenes as we have just witnessed. If it is predictable, it is preventable.
And if you are unlucky enough to have an emergency this winter, remember the carnage around you was a political choice.
If you have an opinion on the issues raised in this article and would like to submit a Letter to the Editor to be considered for publication, please click here
Letters to the Editor are invited on any subject. They should be authenticated with a full name, address and a daytime telephone number. Pen names are not allowed.
