Delayed discharges, or bed blocking as its more commonly known, is when hospital beds are taken up because there is nowhere for patients to go. It is a significant problem in the UK.
It causes issues for the patient, as staying in the hospital often is not the best place for them to receive ongoing care. It also causes issues for the hospitals as they need to free up the beds to treat other patients and every day the bed is used and it is costly for the NHS Trust.
We dug a little deeper into the problem in the UK and submitted Freedom of Information Requests to all NHS Trusts up and down the country. Specifically we wanted to know:
- The number of beds blocked every year
- The total number of days delayed due to beds being blocked
- The reasons for this
- The cost to the hospital and what plans were in place to alleviate the problem
The number of beds blocked every year
In total there was 29,374 beds blocked in UK hospitals in 2018. On average this works out to be 565 delayed discharges in UK hospitals every week.
Looking at individual hospitals and NHS Trusts, we can see that this was the biggest problem in Plymouth, Leeds, Walsall, Bury and Stockton-on-Tees.
|NHS DTOC Beds||2016||2017||2018||Difference||Percentage Difference|
|STOCKTON ON TEES UA||61||121.671||109.18||48.180952||79%|
The total number of days delayed in hospital
The following table details 10 hospitals with the largest increase of days delayed due to the problem of delayed discharge.
|Sum of NHS Delayed Days||2016||2017||2018||Difference||Percentage Difference|
|BATH & NORTH EAST SOMERSET UA||1711||3025||3784||2073||121%|
|STOCKTON ON TEES UA||1993||3570||3323||1330||67%|
Why does delayed discharge occur?
Delayed discharges happen when the person occupying the bed can’t be moved elsewhere due to a lack of suitable alternatives. This could be down to there being no room in a nursing home or residential care home. In some instances it may be down to the family choosing to keep their loved one in hospital as they don’t have the capability to care for them at home. Relatives may also be in the process or organising live-in care or post-discharge care.
The following table illustrates the reasons why beds were blocked and the total numbers for the last three years.
|Sum of NHS DTOC Beds||2016||2017||2018|
|A) Awaiting completion of assessment||6460||5290.6||2836|
|B) Awaiting public funding||1461||1300.5||858.36|
|C) Awaiting further non-acute NHS care||12700||11839||8226.3|
|Di) Awaiting residential home placement or availability||2774||2586.6||2157.6|
|Dii) Awaiting nursing home placement or availability||5200||4311.9||3338.8|
|E) Awaiting care package in own home||3735||3697.4||3203.8|
|F) Awaiting community equipment and adaptations||1359||1352.7||1064.3|
|G) Patient or family choice||7472||6932.1||5290.3|
|I) Housing – patients not covered by Care Act||1888||1904||1872.5|
The cost to the hospital
Each individual hospital and NHS Trust face their own problems and have to juggle their own budgets. Accordingly, the cost per day of a delayed discharge bed varies between hospitals. For some this can be in the region of £400 to £500 every single day, with the average around £325.
The following is a snapshot of the picture across the UK:
- Central and North West London NHS Foundation Trust – £425.64 per day
- Cwm Taf University Health Board – £327.15
- Kent Community Health – £350
- Liverpool Women’s Hospital – £565
- Midland’s Partnership Foundation Trust – £378.73
- NHS Grampian – £727
- North Bristol NHS Trust – £308
- Northampton General Hospital NHS Trust – £180
- Royal Cornwall Hospitals – £345
- Shrewsbury and Telford Hospital NHS Trust – £200
Each NHS Trust and Hospital implements their own plans to help reduce the number of delayed discharges. Procedures in place include:
- Red to Green Traffic light systems to categorise patients
- Daily reviews of all patients
- In-house community support teams to ensure patients get the help they need immediately after procedures and surgery so that they can recover quickly
- Long stay reviews
- Close relationships and ties with housing providers
- Step down projects to support discharge and to secure places within the community
- Integrated discharge teams
The best type of care
Hospitals are for acute treatments and often aren’t the best place for people, especially the elderly, to receive ongoing care. When delayed discharge occurs it is not only to the detriment of the patient, it also impacts the hospital’s ability to treat new patients. Not to mention the money it continues to cost NHS trusts.
Care at home – ongoing care
Anyone requiring care and ongoing support is much better off in an environment that’s tailored to suit their individual care needs. Home care is an ideal solution in many cases as it ensures that a person can retain as much of their independence as possible and can stay in a comfortable and familiar environment
One of the key reasons that many beds are blocked in hospital is down to a lack of capacity in nursing homes or residential care homes. Often it is also done at the family’s request as they might not have the resources to look after their loved one at home.
A solution to both of these issues would be home care. This enables that person to continue living at home and retain as much of their independence as possible. The care that they receive will be provided by a highly-professional carer and will be tailored to their specific care needs and requirements therefore, it will only assist in the areas that they need help.
This could encompass domestic help, companionship or more complex healthcare support for conditions including dementia, Parkinson’s disease, cerebral palsy or multiple sclerosis. It even includes full-time live-in care, if that’s required.