In and out of hospital 11 Mind the gap: views of health and social care professionals and Red Cross volunteers and staff Delayed discharge “ The pots of money for the packages of care “ A patient medically fit for discharge stayed in and all that's been whittled down. If that's the hospital for two weeks waiting for a social gone and your nursing home bed's gone, well care package. That happened so many times that's just going to create crisis in other areas. It's hospitals that are feeling it because we when I was working in the wards… They can't get the patients out, because there's would then pick up other problems. Then they nowhere to get them out to.” would not be medically fit. Then they would Occupational therapist, Manchester go to the back of the queue for the social care because they’re not ready to go – get out Inappropriate discharge of hospital – then they’d be waiting another few weeks for another package of care and “ Sometimes like this 84 year old and they'll exactly the same thing would happen.” go, 'Right, they're medically fit,' and I'd go, Social Worker, Birmingham 'Actually they need their package of care restarting, which might take 24/48 hours.' While over half of delays in discharge in I know the hospital is not always the best October 2017 were attributable to the NHS, environment for people, but for some people 9 just an extra 24/48 hours is enough for with many waiting for ‘non-acute NHS care’ , we know that the lack of available adult social them to go home, be fine, and actually have care is a growing major factor in delaying not come back in. Sometimes even just hospital discharge. In fact, delayed transfers holding them on for 24 hours makes a huge from hospitals due to social care have risen difference, even when you're chocka.” Occupational therapist, Manchester 10 by 65 per cent since 2011. Over a third of delayed transfers are attributable to social The Red Cross volunteers and staff, and care: the main reason for social care delays the health care professionals we spoke to, in October 2017 was “Patients Awaiting Care expressed concern not only about delayed Package in their Own Home”. transfers of care and the impact on people, For older patients in particular, each day in but also about inappropriate discharge. They hospital risks reducing their mobility. Some point to a number of cases where patients have studies have found a reduction in muscle been sent home from hospital before adequate 11 support is available or arranged. strength of as much as 5 per cent per day. Health and social care practitioners raised the “ They've got no family, they've got no one issue of reduced community and intermediate and there's no care package in place for them care services, a corollary of which is patients coming home. They [the discharge team] just staying in hospital longer than they medically ask us to go in, and we go in and we find need to. them, they've either had a fall, they're on the floor and it's because they've been sent back out too soon and they get readmitted again.” Red Cross team member 9 NHS England, Statistical Press Notice Monthly Delayed Transfers of Care Data, England (October 2017). 10 House of Commons Library briefing paper, NHS Indicators; England, (February 2017). 11 National Audit Office, Discharging older patients from hospital, (May 2016).