There is a crisis in hospitals throughout which is recognised, but the knock-on effects of this are increasingly harmful to our health services. The NHS Scotland information services division publishes monthly figures for delays in hospital discharges across Scotland. It reported recently that in January 2017, 1482 people were awaiting hospital discharge despite being clinically well enough to leave. In December 2016, the reported figures were 1333.
The wider picture is very worrying. The Telegraph newspaper reported that between March 2015 and November 2016, nearly 700 people awaiting discharge died before being discharged. It is thought that this is an underestimate due to some Health Boards withholding information for confidentiality reasons.
The BBC reported that some patients (admittedly, a minority of the total), can wait for over a year.
Reasons for delay
The NHS give reasons for delayed discharge as including, in January 2017:
- 70% were aged 75 and over;
- 20% were people with complex care needs;
- 14% were awaiting completion of a post hospital social care assessment;
- 27% were awaiting completion of arrangements for social care support (e.g. carer) in order to live in their own home;
- 24% were awaiting place availability in a care home.
Knock on effects
Having any delay is clearly a serious matter for each individual affected, who is eager to return home. But it also has wider serious consequences. A delayed discharge means the unavailability of a hospital bed, which may mean delayed operations for someone who may need surgical intervention with a period of recovery in hospital. The slowdown of input has a destabilising effect on staff, who struggle in the admission wards to cope with new referrals and admissions. Often they cannot provide the needed medical care, sometimes not even a bed. This lowers morale, and has consequences for recruitment. Health boards are reporting increasing difficulties in recruitment and filling vacancies particularly in specialist fields of medicine.
Of course, there are knock-on effects for the individual as well: they may be clinically ready for discharge, but a lengthy delay may cause other medical issues which can mean a reassessment and further delay in discharge.
Contributing issues
Our health system is under serious threat, and promises by governments to address the problem have not been completely effective.
Reduced funding is part of the problem: some areas are forced to rationalise their hospital provision, meaning more centralised, concentrated services but increasing length of eventual discharge. Some health boards are reported as having unsustainable financial deficits.
Also, funding has become inadequate for some community services. This week Panorama reported that home care services across the country are struggling financially, with some not being able to accept offered contracts as the payment does not enable safe support to be provided. These sorts of difficulties add to the delay in discharge, where a person cannot be safely discharged in the absence of appropriate community support.
At the pre-admission stage, GP services in some areas are depleted due to difficulties in recruitment for medical training. And of course, there is the relentless demographic pressure of a longer-lived, more aged population with more and different health care needs than previously.
Solutions?
A bleak picture emerges of several problems feeding off each other and making it hard to see an overall solution.
I think some of the following could begin to address the issue:
- Cheaper, and more effective community support, such as in the Buurtzorg nome care model, originating in Holland. This provides low cost, neighbourhood care and support by neighbourhood, and is mainly preventive;
- Public health promotion initiatives by Government, such as healthier transport options of walking and cycling;
- Health Boards adopting a more proactive and preventive approach to promoting healthy active living;
- Each person accepting a level of responsibility for the safeguarding of their own health: this might include more active lifestyles, healthier eating, earlier consultation with doctors for problems, and resisting the worst of the stresses that modern life can throw at us.
Overall, let us hope that there is some improvement soon in the harmful obstacle of delayed hospital discharges: these affect individual patients, staff and our health systems generally.
