Bed-blocking: Hospital system 'let my father down'

The latest report shows that 50,340 days were spent in hospital by people whose discharge was delayed in June.

Scottish Government called upon by charity Age Scotland to take action over delayed discharges from hospital iStock

New data from Public Health Scotland has shown the number of people affected by delayed discharge from hospital is higher than pre-pandemic levels, prompting calls to the Scottish Government to take action to reduce the figure.

One 88-year-old man had his discharge from hospital delayed by three weeks after his family were continually told by council social care teams and private care companies that there was “nobody available” in the area.

The man, whose family wished him to be known as Paul, was admitted to Edinburgh’s Western General Hospital at the beginning of February after appearing confused and unwell at a scheduled medical appointment. 

Further investigations showed that the pensioner had suffered two strokes.

He developed delirium on top of existing cardiac issues and was transferred to Edinburgh Royal Infirmary for treatment.

During his hospital stay, it became clear to medical staff, and his daughter Susan, that Paul and his 86-year-old wife Jennifer, would require social care at home before he could be safely discharged.

The couple had previously managed without any support, and neither were keen on losing their independence.  

But Paul’s loss of mobility, his history of falls and Jennifer’s growing anxiety about her husband’s ill health showed a need for a social care package to be put in place to support the couple.

After around six weeks, Paul was deemed medically fit to be discharged but with no social care available, he was kept in hospital.

“It was a very stressful time,” said his daughter Susan. “My mum found it extremely stressful, especially when there was Covid on the ward twice and she couldn’t visit for three weeks.”

The hospital’s recommendation was that Paul receive two social care visits a day, to attend to personal care.

She added: “We kept being told there is nobody available in your area. 

“It was very disappointing. From my parents’ point of view they were people who have paid into the system all their lives and now, at the time when they needed help, they weren’t able to access it.

“Once we were told we couldn’t get support from the council social care, I don’t know how many care companies I called but it was always the same – we don’t have anyone available.

“At one point I thought my dad was going to discharge himself. He was not getting any better because he was so worried about my mum.”

Eventually Susan contacted a private care company that was able to help her parents. They could do one social care visit a day, starting the following week.

After nine weeks in hospital, with discharge delayed by around three weeks, Paul was allowed to go home, but the prolonged hospital stay had caused a noticeable deterioration in his condition.

Susan added: “He had changed. He lacked confidence, was less mobile and had been sitting by himself without any mental stimulation for long periods of time.

“I feel the system let my parents down. At the same time, my parents are lucky – they have me to do things for them, like call care companies, chase up the social work department and speak to doctors. My mum and dad couldn’t have handled this process by themselves. But there must be so many people who don’t have anyone. What can they do?

“In the end my dad was kept in hospital for several weeks after he should have been able to go home because the social care we were told he needed wasn’t available. The delay has had an impact on both my parents – my dad’s physical health and my mum’s mental health.”

Following the publication of new figures from Public Health Scotland which showed that the number of people affected by delayed discharge is higher than pre-pandemic levels, with 1,671 cases in June, Age Scotland is calling for urgent action to tackle the social care crisis.

The report shows that there were 50,340 days spent in hospital by people whose discharge was delayed in June, an increase of 36% compared with June 2021 (37,136). 

The average stay in hospital increased to 23 days in June from 21 days in May.

The charity estimates that bed-blocking is costing the NHS more than £400,000 a day.

The vast majority of cases involve older people who are awaiting a social care package at home or a place in a care home.

Although the number of delayed discharge cases dropped during the first Covid-19 lockdown due to the emergency measures which saw rapid scale discharges to care homes, the latest figures which were released on Tuesday show that the issue is now worse than it was before the pandemic.

Brian Sloan, chief executive of Age Scotland, said: “Too many people are spending far too long in hospital when they don’t want, or need, to be there largely because there isn’t enough social care available in their community to support them.

“The impact this has on their health, mobility, loneliness and long-term independence is extraordinarily negative. Three weeks spent in hospital when you don’t need to be there can have the same effect on an older person as ageing by 30 years.

“There is clearly no easy fix for this but there just doesn’t seem to be a practical plan to significantly reduce delayed discharge levels. A National Care Service in the future does nothing for the crisis we face today, next week or next month.

“Of course, we face some unprecedented challenges across Scotland right now as health and social care partnerships are dealing with chronic staff shortages, in part due to Covid-19 but also the loss of EU workers, but this is beginning to feel like groundhog day. These repeatedly sky high numbers month after month are leaving so many older people without enough of the care they so desperately need.

“It is vital that the Scottish Government and local authorities get together as a matter of urgency to ensure that more qualified staff are recruited to help older people in need. Paying workers a fair wage and investing in a life-saving service must be made a priority to prevent a bad situation becoming even worse.”

A Scottish Government spokesperson said: “Being at home or in a community setting is in the best interests of anyone who no longer has any clinical need to be in hospital.

“The Scottish Government works with health and social care partnerships to reduce delays in people leaving hospital and to ensure that people are cared for in the right setting and hospital beds are there for those who need them.

“Along with significant additional funding to support social care, including £62m to enhance Care at Home capacity and £48m to increase hourly pay, £40m to provide interim care arrangements; and £20m to enhance multi-disciplinary teams, we have improved discharge planning arrangements.

“We have taken steps to rapidly scale up Hospital at Home services to reduce acute admissions and support timely discharge. A further £3.6 million funding has been made available in the 2022/23 budget to support the further development of Hospital at Home across Scotland. 

“We have recruited more than 1,000 additional healthcare support staff since last October with many working in community and social care. Ministers continue to meet regularly with the partnerships facing the most significant challenges to discuss progress and challenges.”