Revealed: ICSs with biggest discharge problems

More than a quarter of integrated care systems nationally have at least one in five beds occupied by patients who are fit for discharge, according to figures published by the Department of Health and Social Care.

The problem is worst in the South West, which has the top five areas hardest hit by delayed discharges, and where the proportion of patients stuck in hospital is as high as 28 per cent in the Bristol, North Somerset and South Gloucestershire system.

Delayed discharges are often the main cause of overcrowding in emergency departments, and ambulance handover delays, for which the South West has been a significant outlier.

The region has an older population than the England average and may have suffered more with staffing problems through a combination of remoteness, cost of living and reliance on EU staff who have left due to Brexit — leading to more severe problems in social care services. 

The figures were published last week by the DHSC, alongside details of the £500m winter discharge fund, split between councils and ICBs and targeted at areas with the most patients awaiting discharge.

Ministers have set a series of conditions for the extra cash, including that ICSs ensure support for patients to be discharged “throughout the week, including at weekends”.

Average bed occupancy rates between July and September reveal 15 per cent – around one in seven – of acute hospital beds in England were occupied by patients with “no criteria to reside”.

However, the rate increased to one in four or higher at four ICSs in the South West: Bristol, North Somerset, South Gloucestershire (28 per cent); Dorset (26 per cent); Cornwall (25 per cent) and Gloucestershire (25 per cent).

The £500m fund, announced by former health and social care secretary Therese Coffey in September, will be distributed in December and January. ICSs will get £300m and local councils £200m, to be used flexibly on measures that support hospital discharge such as investing in discharge to assess and a “home first” approach, according to allocation details.

The money, which will be pooled into the Better Care Fund, can also be used to support the social care workforce, including through retention bonuses or bringing forward pay rises.

Strings attached to the funding were set out in a letter from social care minister Helen Whately published yesterday, including a mandatory progress review in January across “all local authorities, ICBs and trusts”.

Accompanying guidance says areas seeing higher levels of delayed discharges will be “offered a package of support to encourage improvement”. It continues: “In these cases, the expectation will be that ICBs (including relevant trusts) and local authorities will implement the recommendations provided by the support programme teams.”

Funding discharge to assess schemes across the country could free up as many as 6,000 hospital beds and save the NHS £7bn by 2031, according to a government impact assessment published earlier this month.