National Audit Office 26 May 2016
- This report examines how effectively the health and social care system is managing the discharge of older patients from hospital, in particular:
- the scale of delays that older patients experience in hospital (Part One);
- the extent to which health and social care providers are adopting good practice in discharging older patients (Part Two): and
- barriers to local health and social care systems working effectively (Part Three).
- Includes local data tables for Delayed discharges, A&E admission LOC and Adult social care spend
- Key findings
- Rising demand for services, combined with restricted or reduced funding, is putting pressure on the capacity of local health and social care systems
- The number of recorded delayed transfers of care has increased substantially over the past two years.
- The delayed transfers of care data substantially underestimate the range of delays that patients experience.
- The NHS spends around £820 million a year treating older patients who no longer need to be there.
- Caring for older people who no longer need to be in hospital in other settings could result in additional annual costs of around £180 million for other parts of the health and social care system.
- Recommendations: The Department, NHS England and NHS Improvement have work under way to better coordinate the central assurance and support for patient flow and discharge. We encourage the continuation of these initiatives. However, we do not consider incremental operational improvements alone will address the problem effectively.
- a The Department, NHS England and NHS Improvement, in conjunction with local government partners, should set out how they will break the trend of rising delays against the demographic challenge of growing numbers of older people, with a particular focus on minimising avoidable admissions and inappropriate lengths of stay, drawing on existing initiatives as much as possible.
- b Working with the Discharge Programme Board, NHS England should develop measures that fully capture the number of older people who are no longer benefiting from acute care. This may involve changing the current definition of the delayed transfers of care metric together with the use of a range of other metrics relating to patient flow in hospital.
- c Building on the initial work set out in this report, the Discharge Programme Board should coordinate work to fully understand the cost to hospitals of delayed patient discharge and the costs, where these fall on the public purse, of caring for these people in the community.
- d Health and social care commissioners should incentivise known good practice (including the recently published NICE guideline) in patient flow and discharge planning and reduce, by targeted amounts, the number of older patients unnecessarily delayed in hospital. This should include use of
- the recently published Commissioning for Quality and Innovation (CQUIN) relating to discharged patients returning to their usual place of residence within seven days of admission.
- e NHS England and NHS Improvement should seek to understand which contracting and payment mechanisms offer the best incentives for community health providers to increase activity when required.
- f NHS England should evaluate the effectiveness of system resilience groups and consider how they can be strengthened to support whole-system strategic planning and ownership of the discharge process and fit clearly with other local networks and programmes.
- At the Public Accounts Committee session (6 June 2016, "Effective discharging of older patients from hospital examined") Simon Stevens contested the NAO estimate of the cost of DTOC.
