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A new report has found that the UK is falling behind other countries in discharging medically fit patients from hospitals. This is due to under-investment and a lack of coordination within the health and care system. The NHS has long prioritized moving patients into community settings to free up hospital beds, but progress has been minimal in England. The Nuffield Trust, in its report, highlighted the “insufficient capacity in community health and care services” as a major obstacle. While the average length of hospital stays for UK patients is comparable to other countries, the UK seems to be slower in sending patients home compared to countries like Sweden, Denmark, and the Netherlands.
The difficulty in discharging patients who are fit to leave has caused waiting lists for non-urgent treatment in England to increase. This backlog, which currently stands at 7.6 million, has become a priority for Prime Minister Rishi Sunak, who pledged to reduce waiting lists before the upcoming elections. Nigel Edwards, CEO of the Nuffield Trust, pointed out that the NHS has invested too much in preventing hospital admissions and not enough in improving care for patients who could be better cared for outside of hospitals.
Data from NHS England reveals that the number of patients fit to leave hospitals but still awaiting discharge has increased by 27% in the year up to December 2022. Among those who have been admitted for three weeks or more, 70% are waiting for community health and social care services. Additionally, the proportion of the NHS budget allocated to primary care and community services has fallen in the past three years.
One key difference between the UK and other countries is the responsibility for community health and social care services. In other countries, local municipalities handle these services, while in England, it is split between local councils and the NHS. This has created a “vicious cycle” where patients are discharged without the necessary support, leading to higher readmission rates.
While a community-centric approach has shown promise, successful implementation requires ample funding. Denmark, for example, saw a decrease in inpatient services expenditure when care shifted to outpatient settings. However, structural changes alone may not be sufficient and can expose funding and staffing disparities among municipalities. In the Netherlands, evaluations of long-term care reforms have shown that smaller municipalities lack the capacity to carry out their responsibilities effectively.
The Department of Health and Social Care stated that efforts are being made to ensure patients leave hospital as soon as they are medically fit. They have invested £1.6 billion to support this, along with an additional £700 million to alleviate hospital pressures and provide more care packages and beds. NHS England has also expanded the use of out-of-hospital care and increased the number of patients treated at home or in the community.
In conclusion, the UK’s struggle to discharge medically fit patients from hospitals is a result of under-investment and a lack of coordination. While progress has been made in other countries, England has fallen behind in shifting care to community settings. The NHS must focus on improving capacity in community health and care services to address this issue. Efforts are being made, but funding and coordination remains a challenge.
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