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The time needlessly spent in hospital by patients who are medically fit to leave has been cut by almost a third across Lancashire and South Cumbria in the last two years.
The number of so-called “additional bed days” – a measurement of how long patients remained in hospital after a decision had been taken to discharge them – fell from 2,665 days at the end of November 2022 to 1,815 by the same point in November 2024.
However, the latter tally is a slight increase on an even larger fall seen during the corresponding month-end in 2023, when the figure – derived from those people who had been admitted to a ward for at least a week – dropped to 1,494 days.
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Delays occur when the practical support needed by a person to return to living safely in their own home – or a temporary or permanent place in a care facility – is not arranged soon enough.
A meeting of Lancashire County Council’s health and adult services scrutiny committee last month heard that the long-term reduction in hold-ups was the result of greater collaboration between the NHS and local authority social care teams.
Heather Woodhouse, the integrated place leader for the North Lancashire place-based partnership, said the joint focus of all involved was “trying to do the right thing” for the patient. She added that much of the work being done to cut delays did not even cost the public purse more money.
“Often, it’s about staff and teams on the ground working together in a more integrated way. The impact that we’ve been able to have around discharge is because we’ve been able to put staff together, all looking at the same problem at the same time.
“When [financial challenges] are there, we do have to pull together,” Ms. Woodhouse explained.
Paul Lee, the county council’s director of adult care and provider services, acknowledged the pressures the sector was under, including as result of staff shortages because of “recruitment and retention” issues. However, he said the Lancashire-wide workforce was flexible and was being sent to “where the pressure points are”.
“If, for example, Blackpool is really pressurised and East Lancashire isn’t, we’ll move staff across,” he said.
Under government guidance issued last year,”a high proportion” of patients on a hospital’s discharge list should leave on the same day it is decided that they no longer need to be on a ward.
As well as causing a blockage in the flow of patients through the hospital system – which is often then felt at the ‘front door’ in the form of congested accident and emergency departments – delayed discharges are also bad for the patients who end up in bed for longer than necessary. Research has shown that even just 10 days of bed rest in healthier older adults leads to a loss of physical ability.
What’s making the difference?
A report presented to the scrutiny committee noted that Lancashire County Council had developed several different services and strategies to ensure timely discharge of patients from hospital. It was a pioneer of the so-called ‘home first’ principle eight years ago, whereby support is put in place to meet a person’s immediate care needs after leaving hospital, but a more detailed assessment of their longer-term requirements is only made once they are back in their own home or another facility.
County Hall has also commissioned 116 rehabilitation beds in the community to provide short-term support to those ready to leave hospital, but not quite fit to return home.
The authority also operates a ‘home recovery’ discharge scheme, under which one-off grants are offered to unpaid carers to help overcome “small barriers” to them being able to care for a loved one for a short period after they leave hospital. The initiative also funds any necessary small household items needed for a patient to return home.
The county council supports more than 13,000 people a year on “pathways” out of hospital which will see them return home with a care package, transfer into a temporary community rehab facility or move into a care home.
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