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NHS spends £820m a year keeping older patients in hospital unnecessarily

BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i3019 (Published 26 May 2016) Cite this as: BMJ 2016;353:i3019
  1. Adrian O’Dowd
  1. London

The NHS in England wastes nearly £1bn (€1.31bn; $1.47bn) every year treating older patients in hospital who no longer need acute care, the National Audit Office (NAO) has said.

On 26 May the public spending watchdog published Discharging Older Patients from Hospital,1 in which it said that health and social care services’ management of discharging older patients from hospital did not represent value for money.

The NAO estimated that the gross annual cost to the NHS of treating older patients in hospital who no longer need acute clinical care was around £820m. This was a waste of money and was bad for patients, said the authors, because longer stays in hospital can negatively affect older patients’ health owing to lost mobility and the inability to do everyday tasks.

The report said that, despite efforts to rectify the situation, an ageing population and more older people being admitted to hospital necessitated a “step change” in performance to resolve the problem.

Official data on the past two years showed growing pressure on the system: days spent in acute hospitals by patients who had had their discharge delayed unnecessarily increased by 270 000 (31%) to the current figure of 1.15 million days. The true number may be even higher, as the NAO said that these figures accounted only for delays after clinicians and other professionals had deemed a patient ready for discharge.

The report also noted an 18% increase in emergency admissions of older people from 2010-11 to 2014-15, and it found that almost two thirds (62%) of hospital bed days were occupied by older patients in 2014-15.

The NAO recommended that the Department of Health, NHS England, and NHS Improvement should set out how they plan to reverse the trend of rising delays in view of the growing numbers of older people.

Amyas Morse, head of the NAO, said, “While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there.

“Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.”

Meg Hillier, chair of the parliamentary Public Accounts Committee and Labour (Co-op) MP for Hackney South and Shoreditch, said, “For the sake of older patients and the financial sustainability of the NHS, hospitals and local social services have to get their act together to discharge people more quickly when it is safe to do so.”

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