Nowhere to go: Elderly patients die in Scots hospitals as delayed discharges escalate and charities call for more community care
Fit to leave hospital but nine people are dying on our wards every week because care and support cannot be put in place for them at home
An increase in delayed discharges from Scots hospitals is risking the lives of elderly patients, experts warn today.
A 12% rise in so-called “bed-blocking” has led to questions over the Scottish Government’s flagship policies to strengthen care in the community.
Doctors fear many older patients never recover from the physical effects of lengthy stays in hospital, with at least nine Scots a week dying in hospital while waiting for care to be arranged allowing them to be discharged.
Yesterday, campaigners for the elderly called for a full review of the care system and investment in communitybased support for those leaving hospital.
Brian Sloan, chief executive of Age Scotland, said: “Research has found
‘ Hospital can age a patient by 30 years
that an unnecessary three weeks in hospital effectively ages a patient by 30 years.
“This gives rise to the genuine fear among some older people of going into hospital, in case they never leave. Staying in hospital longer than necessary can have an adverse effect on an older person’s health, putting them at greater risk of infection, loss of mobility, isolation and loneliness.
“We want to see a threepronged approach to improving social care.
“Funding, yes, but also a concerted, long-term campaign to recruit more staff and a commitment to reforming the health and social care system to provide sustainable communitybased support that will take the pressure off hospitals and allow older people to be cared for closer to home.”
In Scotland, almost 1,500 patients a day are stuck in hospital instead of recovering at home, at a daily cost of £360,000.
The latest figures showed 1,379 people had their discharge from hospital delayed at the 2019 census point (the same day every month when bed blocking is counted), a 12% increase on the figures for December 2018. Almost half were over 75.
In December, there were 45,404 days spent in hospital by people whose discharge had been delayed, an increase of 6% compared with the 42,732 delayed days spent in hospital in December 2018.
The government insists health and social care partnerships are working, and claim lost bed days are down since 2016 when the new integrated care system was brought in.
Dr Lewis Morrison, consultant geriatrician and chair of the British Medical
Association Scotland, said: “People who should be at home or in a place of permanent care are effectively stuck in and unable to leave the NHS, and often for weeks or months beyond the time they are ready to be discharged.
“This is often for some simple reasons. These usually centre on a lack of home care and not enough care home places, or not enough money to pay for those. Some of those very fragile people never get home as a result, others suffer weeks of frustration and detrimental physical and psychological effects.”
Philip Rowe, professor of rehabilitation at the biomedical engineering department of the University of Strathclyde, warns unless the current system changes, many more care home places will be needed.
He said: “We need to turn the system around and do everything we can to support older adults stay functionally independent in their own homes for as long as possible and not go into hospital, where they get stuck.”
The Scottish Government said: “We are increasing our package of investment in social care and integration by 14% to £811 million in the 2020-21 budget to ensure health and social care services are fully joined up for patients.
“This investment will build still further on a 29% increase on spending in
this area this current year compared to last year.”
But the differences across the country are dramatic, with increased delays in Clackmannanshire up 81% despite £181m being allocated last year to the social care partnership, up from £126m in 2016.
Delays in hospital discharges are up 52% in Ayrshire, East Dunbartonshire up 41%, and Glasgow 29%.
Patients in Edinburgh and the Lothians can wait 35 weeks for care to be put in place, and last year 86 patients died waiting.
Figures across Scotland show as many as nine people dying in hospital every week while waiting for care.
Research has also shown one in five elderly patients who walk into hospital are unable to walk out again unaided because of the delays.
Scottish Conservative health spokesperson Miles Briggs is demanding an urgent review of the system and how care is delivered. He is also calling for consideration to be given to the return of “cottage style” hospital units to help vulnerable patients recuperate.
He said: “There is no doubt that Scotland is in the grip of a social care crisis.
“More than one in 10 beds are being taken by someone who is medically fit to leave hospital and that isn’t good for that person or for the capacity of hospitals across the country.
“It’s deeply concerning we’re seeing people leaving hospital far less physically able than when they arrived due to the fact that they have lost muscle capacity, all because of delayed discharge.
“Scottish Government ministers have been promising for years to abolish delayed discharge.
“But the reality is that on their watch, we’re seeing it increase. Our most vulnerable patients are paying the price.”
The MSP is calling for review to consider what is happening in other countries.
He said: “Norway obliterated delayed discharge by using community-centred units, similar to the old-style cottage hospitals which they use to provide step-down care so patients can recuperate.
“That may not be useful in cities, but it could be a vital service in smaller towns and more rural areas.”
The Lib Dem’s Alex ColeHamilton said it is “time to end the social care scandal”.
He said: “Keeping someone in hospital unnecessarily for a year costs the NHS almost £100,000. Hospitals are getting congested all the way up to critical care as there isn’t enough capacity to take care of people in the community.
“Even more damaging is the crushing cost to patients’ wellbeing. Conditions worsen and critical opportunities to rebuild their lives are lost. It’s miserable.”
Scottish Labour health spokesperson Monica Lennon said: “This is a national disgrace which is denying dignity to older people and people with disabilities. We can’t continue to do social care on the cheap.”