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Failure to discharge older patients on time costs the NHS millions

Failure to discharge older patients on time costs the NHS millions

The NHS is losing money by keeping older patients in hospital for longer than is necessary, said the NAO in a report
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The NHS is losing money by keeping older patients in hospital for longer than is necessary, said the National Audit Office (NAO) in a report.

The spending watchdog estimates the NHS is spending £820 million on treating older patients in hospital who no longer need acute clinical care.

The report, Discharging older patients from hospital, estimates that care in more appropriate settings, either at home or in their community, would cost closer to £180 million.

The Royal College Nursing (RCN) has called for greater investment in community services, which it says, will allow older people to receive more appropriate care.

Anna Crossley, RCN professional lead for acute, emergency and critical care, said: “Keeping an older person in hospital when they are well enough and want to go back to their own home benefits no-one.

“Older people’s routines are interrupted and their ability to cope by themselves reduced if they are needlessly kept in hospitals.

"This can lead to their health declining and a premature admission to a care home."

The NAO report emphasised the importance of achieving the correct balance between shorter delays and not discharging patients too soon.

The report says that data on delayed transfers of care under-estimate the range of delays that patients are experiencing.

Over the last two years there has been a 31% increase in days when acute hospital beds have been occupied by patients who have had their discharge unnecessarily delayed to 1.15 million days.

However, the report says these figures only account for delays after clinicians and other professionals believe a patient is ready to be discharged.

It does not take into account the patients who no longer need acute care, which, the report says increases this figure to approximately 2.7 million days.

While some efforts have been made to shorten hospital stays for older people, the report says these new figures call for more to be done as the population continues to age.

In 2014-15, 50% of older people were admitted to accident and emergency, compared to 16% of those under 65.

The report adds that providers and commissioners said that staff recruitment and retention were a significant cause for these delays.

They reported that vacancy rates for nursing and home care staff were up to 14–15% in some regions, and fewer than half of hospitals felt they had sufficient staff trained in the care of older patients.

A spokesperson at the National Institute for Health and Care Excellence (NICE) said: “Our social cares guidance, ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’, recommends offering older patients early supported discharge.

“This is where a patient can be discharged from hospital early to receive rehabilitation support at home.

“Our guidance also recommends that one person, either from the hospital or community-based team, should be made responsible for a patient’s discharge from hospital.

“The report also highlights the importance of implementing our guidance as good practice. To help address this, we are producing a quality standard on transitions for adults with social care needs that focuses on particular areas of improvement.”

NAO recommends in the report that “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.”

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