Patient spends more than a year in hospital despite being fit enough to leave

A patient well enough to leave hospital has been waiting more than a year to be discharged because of delays getting care to help them go home or to another setting. Ministers said waits like this at the University Hospital of Wales (UHW) in Cardiff are “unacceptable” as they gave health and local authority bosses a 50-day target to discharge more than 300 of the longest-waiting patients by the end of the year.

The patient in Cardiff is among 1,596 people still in hospitals around Wales 48 hours or more after being assessed as medically well enough to leave. Some have been left waiting far longer than 48 hours. The Welsh Government is now launching a drive to get 25% of these patients out of hospital by the end of the year saying the NHS and local authorities must work together better.

Ministers say measures that will help achieve this target include moving towards a seven-day working pattern to allow weekend discharges, more assessments in the community, and beefing up GP services in care homes. Delays are being caused in assessing and agreeing patients’ care needs outside hospital with growing numbers of younger patients also now affected, doctors and health bosses said.

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Describing how one patient in her hospital is still there more than a year after being assessed as medically fit enough to leave Dr Katja Empson, emergency unit consultant and medicine clinical board director at UHW, said each case is different but the bottom line was “we can’t get care in place quick enough”.

“We have had someone in the hospital over a year. Some patients have a really poor experience,” Dr Empson admitted. “They are medically well and don’t need ongoing treatment but their [care] needs are complex. Once people are in hospital more than two or three weeks they become more and more dependent.”

Worsening health among younger people means “bed blocking” like this, usually associated with older patients who may need more support to leave hospital, now involves younger people too, said Dr Empson. Obesity, addiction, and mental health are among issues delaying discharge of younger patients.

“The worrying thing is the complexity of cases among younger people. People in their 50s are having more complex problems. Dementia is a huge area that has also increased in complexity.

“With care homes there are delays around how they are financed, the person’s preference, and their family agreeing. There is not a shortage or carers or care homes here but it’s the complexity of setting it up.

“Here in Cardiff and the Vale there are enough carers. It’s more about the complexity of the individual – they may have dementia. Some families do refuse to have relatives home and some are desperate to get them home.

“Some people see hospital as a safe place to be and frail people can be at risk of another fall. Getting a carer is not something we can do quick enough.”

Dr Empson said there may also be other delays getting the necessary local authority social services assessments for home safety. Discharge can be a complex arrangement involving family, social services, carers, community health teams, and community nurses.

Told about the patients waiting more than a year minister for children and social care Dawn Bowden said this was “unacceptable”. Launching the Welsh Government’s 50-day challenge to get a quarter of the longest waiters out of hospital by the end of the year Ms Bowden said it was a matter of working more effectively rather than just funds.

“A whole range of things are needed and yes it’s money but it's not just about money – It’s about culture and working together effectively. Local authorities and the NHS need to work better together. There is good practice and we need to share that. In Cardiff and Vale there is close partnership but that may not be happening everywhere around Wales. They have shared local authority and NHS offices and staff in the hospital."

Health minister Jeremy Miles said he will be checking data each week on long discharge waits. “We are asking health boards to look at the 300 people waiting the longest, the 25% of those waiting to leave hospital, and we want that sustained beyond the end of the year. We will look at this every week. It’s about more collaborative working – some things are cost-neutral. It is unacceptable that anyone is waiting too long to be discharged.”

The Welsh Government said the NHS in Wales – like the NHS in other parts of the UK – is experiencing persistently high levels of delayed discharges which negatively affect people’s health and the health and care system. All health boards and local authorities have accepted the 50-day integrated care winter challenge set by ministers, which will run to the end of the year. The £146m regional integration fund, the £11.95m Further Faster fund, and the £5m allied health professional funding are helping to build community capacity in the system, the statement added.