NHS red tape fuels doubling of patients stuck in hospital more than three weeks

NHS hospital - Getty Images
NHS hospital - Getty Images

Bureaucratic delays have fuelled a doubling in the number of patients stuck in hospital for more than three weeks, an investigation reveals.

Experts warned that thousands of patients – largely elderly – are being left to deteriorate, amid wrangles over paperwork and assessments.

Charities said too many patients were being left “to become a shadow of their former themselves” and stripped of mobility and independence as delays mounted.

NHS data, revealed under Freedom of Information disclosures, shows 19,308 patients stuck in hospitals in England last December for at least three weeks. The figure has almost doubled from 10,922 in December 2020.

Those enduring three-week stays were delayed for 21 days on average, after being declared fit for discharge, analysis by the Nuffield Trust think tank found. The year before, the average delay for such patients was 12 days.

Health experts said that difficulties finding places in care homes, or help at home, were too often blamed for such delays.

Overall, just 15 per cent of all patients discharged from hospitals in England between October and December last year were deemed to need help at home, rehab, or care-home places, the analysis found.

Often, hold-ups occurred elsewhere in the process – with patients stuck in hospital beds as they endured repeated assessments, despite being declared fit for discharge.

Earlier this year, an investigation by The Telegraph revealed that hospital staff have to complete an average of 50 separate steps in order to discharge a patient.

In total, the number of delayed discharges among patients with stays of at least three weeks in hospital rose from 2,527 in December 2020 to 6,933 last December, the new figures show.

Among patients who had been in hospital for at least three weeks and should have been discharged, just 25 per cent were stuck waiting for a bed in a nursing or care home. A further 23 per cent were waiting for home care, the analysis of data from October to December 2022 found.

The remainder were waiting for medical paperwork to confirm they were fit to go, further assessments, agreement on what further care was needed, short-term beds, or other reasons.

The analysis is based on FOI disclosures from NHS England, which collects weekly information from the 121 acute trusts in England.

Caroline Abrahams, charity director at Age UK, said the findings were “extremely sad” with far too many elderly people stuck in hospital for “much longer than is good for them, or for the NHS”.

She added: “With the right help at home or in a residential care setting these older people will often get better and be able to take up where they left off before their hospital stay, but as it is too many are stuck in a hospital bed, frozen in time, getting depressed, and slowly but surely losing their physical capacity through inactivity.

“In these circumstances, the risk is they eventually emerge from hospital as only a shadow of their former selves, when with the right out-of-hospital resources in place this could have been avoided.

The findings follow warnings from health chiefs that elderly patients stuck in hospital can age 10 years in 10 days, because of the amount of muscle mass lost as they become bed-bound.

Earlier this year, a survey by CHS Healthcare found half of hospital workers said that paperwork, red tape and bureaucracy caused delays in discharging patients.

The analysts said an average of 50 different actions – such as completing paperwork, arranging transportation, and approving funding – are now  required to discharge a hospital patient.

This winter, the country’s most senior A&E medic likened NHS hospitals to “lobster traps”, describing them as “easy to get into but hard to get out of”.

Long hospital stays can be ‘harmful’

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said he was “desperate” to keep his elderly parents from going into hospital because long stays could be so harmful to the elderly.

Latest figures show around 13,000 patients a day are stuck in hospitals in England despite being deemed fit to go.

Dr Sarah Scobie, deputy director of research at the Nuffield Trust, said: “Month after month we see performance figures from the NHS showing how long people are waiting to get admitted to hospital or see a specialist. But there is much less routine data on the other side of the story: people who are ready to leave hospital but can’t get out.”

“Our figures shed light on this issue, revealing a complex mix of problems, including delayed hospital discharge processes, a lack of NHS community services and more well-known problems in social care.”

Separate research by charity the Health Foundation earlier this month suggested that the NHS itself is responsible for about two thirds of delays getting patients home.

‘Considerable pressure’

An NHS spokesman said: “Delayed discharges put considerable pressure on the NHS, and these rose by more than a quarter in 2022 despite staff working hard to send more patients home on time than ever before.”

Such efforts had reduced the number of delays within hospitals’ control by a quarter, he added.

The spokesman added: “We only discharge patients when we know there is appropriate care for them to go to, and the reasons for delayed discharges are complex.”

He said some were waiting for short-term beds, some for the right care at home and others waiting for step-down community care, which often has high occupancy and challenges discharging patients to social care.

He added: “NHS teams are continuing to work closely with colleagues in social care, and as part of our urgent and emergency care recovery plan we are rolling out a range of measures, including thousands of extra beds, greater use of virtual wards and more step-down care to help get more patients home sooner.”