The long goodbye

5 min read

There’s a shortage of hospital beds, yet many thousands are occupied by those who neither need nor want to be there. We look at the problem – and find some innovative solutions

Nobody wants to be in hospital, but that’s especially true for those who have finished treatment and been told by their doctor they can leave. Yet incredibly, nearly 15,000 people are likely to be in this unhappy position right now, according to research based on previous winters.

At the peak of the NHS’s perennial winter crisis last January, 14,710 hospital beds – out of around 100,000 in England – were occupied by people deemed fit to leave but unable to do so.

The reasons for this predicament, sometimes unfairly called ‘bed blocking’, are complex. Around half are patients waiting for a home care package or a place in a care home, says Charles Tallack, director at charity The Health Foundation and author of a recent report on the problem. ‘Staff are under terrific strain and if they’re trying to find beds for people from A&E it can be hard to spend the time needed on discharge.’

Emma Dodsworth, researcher at the Nuffield Trust, which monitors hospital discharge delays, says around a quarter are down to admin issues – for example, the need for a pre-discharge assessment, a sign-off or discharge summary.

For older people forced to stay in a hospital bed for weeks or sometimes months, there can be dire and long-lasting consequences. These range from a higher risk of hospital-acquired infection to malnutrition, dehydration and accelerated loss of muscle mass and strength.

A 2020 study of previously hospitalised older people found that six months after discharge, 43% needed continuing help with medication, 24% could not walk a quarter of a mile, 35% had trouble preparing meals, and 45% could not drive. Deprived of activity and the stimulus of everyday life, mental health and cognition can also suffer, says Dr Lucy Pollock, consultant geriatrician at Somerset NHS Foundation Trust and author of The Book About Getting Older (Michael Joseph). ‘People can become mentally deconditioned, especially when they get out of the habit of making their own plans,’ she says. ‘Plus, disturbed nights, lack of sleep and seeing sights you’d prefer not to see can be depressing.’

Last September, the government announced funding of £200 million to help support the NHS through the winter, together with £40 million to bolster social care capacity and improve discharge from hospital. This was on top of £600 million already pledged to help with recruitment and retention in social care. But some experts say these measures are short-term and piecemeal. Successive governments have failed to reform social care and integrate it with the health service.

What can you do to help a loved one in hospital get out quickly? ‘The conversation about getting out

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