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NHS leaders pledge to cut delayed discharges by 25%

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2610 (Published 13 June 2018) Cite this as: BMJ 2018;361:k2610
  1. Gareth Iacobucci
  1. The BMJ

NHS leaders have set the service an ambitious target to reduce long hospital stays by 25% as they strive to avoid a repeat of the “perfect storm” that gripped the NHS last winter.

The joint announcement by NHS England and NHS Improvement was made at the NHS Confederation conference in Manchester on 13 June.

Simon Stevens, NHS England chief executive, said that hospitals and local councils had made progress in tackling delays in patients being discharged over the past year, but he warned that more action was needed.

“We’ve still got real problems with the way in which patients are able to be discharged,” he said. “That is why one of the principal operational focuses for the NHS over the year ahead has got to be building on the progress that we’ve all made on delayed transfers of care.

“The fact that we have perhaps a fifth of our precious hospital beds occupied by folks who have been there for more than three weeks and are ready to go home, is an affront to patient dignity, has consequences for our ability to admit emergency patients through A&E, and is crowding out the ability to admit people who need routine surgery.”

The pledge comes as the NHS continues to draw up plans for next winter, after it struggled to cope last winter with bad weather, a flu epidemic, and a record number of emergency attendances and admissions.

The NHS estimates that, of almost 350 000 patients who currently spend over three weeks in hospital each year, many do not need to be there for medical reasons. National bodies said that a 25% reduction in delayed discharges could free up over 4000 beds in time for next winter.

To help the NHS achieve this, trusts will be expected to close the gap between the number of patients discharged during the week and those sent home at the weekend. They will also be expected to make greater use of alternatives to hospital admission, such as emergency day cases or therapy services.

The NHS will treat hospital stays that exceed best practice guidelines as a safety issue that needs urgent attention. It will also closely monitor the time patients have spent on wards, using the patient administration system.

Stevens said that around half of the proposed “unblocking” would be “in the gift of acute trusts” but that the other half would need action from community health services, councils, GPs, and clinical commissioning groups, through initiatives such as greater support for care home staff to prevent residents being admitted to hospital unnecessarily.

Ian Dalton, NHS Improvement chief executive, acknowledged to the conference that the target was “a big ask.” But he urged local organisations to act now and to work together in preparing for next winter.

“The acute sector cannot deliver this on its own,” he said. “This vital objective is an action call for the whole system.”

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