Discharge delays reach eight year high as social care budgets are squeezed

BMJ 2015; 351 doi: (Published 22 October 2015) Cite this as: BMJ 2015;351:h5613
  1. Zosia Kmietowicz
  1. 1The BMJ

Cuts to social care budgets are adversely affecting health services, and delays in discharge from hospital are at their highest since 2007, says a report from the health think tank the King’s Fund.

Nearly nine in 10 (88%) NHS trust finance directors and 80% of finance leads in clinical commissioning groups who responded to a survey from the King’s Fund thought that funding pressures on local authorities had negatively affected performance of health services in their area.

Altogether 90 trust finance directors (37% of those contacted) and 50 CCG finance leads (27%) responded to the survey, which was carried out in September for the fund’s quarterly monitoring report of health and social care services in England.1

The number of patients who experienced delay while being transferred from hospital to the community on the last Thursday of August 2015 was 5169, up 25% from 4144 in August 2011.2

Most delays (62%) in 2015 were attributed to the NHS, with 31% attributable to social care, and 7% to both sectors. The main reason for NHS delays was “patients awaiting further non-acute NHS care,” which accounted for 25 500 delayed days in 2015 (28.4% of all NHS delays).

The King’s Fund is calling on the government to use its forthcoming spending review to protect social care from further budget cuts and reinvest the £6bn previously earmarked for implementing the recommendations of Andrew Dilnot’s review of adult social care. The Dilnot reforms have been now delayed.

The survey of finance directors confirmed that the NHS was heading towards the financial crisis indicated by figures released earlier this month, which showed that hospitals in England recorded a combined deficit of £930m (€1.3bn; $1.4bn) in the first months of 2015-16.3 Almost two thirds (63%) of the finance directors surveyed by the King’s Fund forecast a deficit at the end of the financial year.

More than a quarter (27%) of finance directors said that measures to cap spending on agency staff, provisionally set to start on 23 November, will affect their ability to ensure safe staffing levels.

The latest figures show that pressure on the NHS was mounting, even in the traditionally less fraught summer months. In August 5.7% of patients waited longer than four hours in hospital emergency departments (missing the 5% target), and at least 3.3 million patients were waiting for elective care, the highest number since January 2008.

Commenting on the report, John Appleby, chief economist at the King’s Fund, said, “The quarterly monitoring report reveals the financial crisis engulfing the NHS and social care. With winter approaching, the NHS faces a toxic mix of widespread deficits, rising waiting times, and low morale.”

Appleby added, “There is now clear evidence that cuts to social care budgets are affecting the NHS, as well as reducing services for people that need them. The government must use the spending review to protect the social care system from further cuts and reinvest the £6bn previously earmarked to implement the Dilnot reforms.”


Cite this as: BMJ 2015;351:h5613


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