Hospitals: Delayed Discharges

Question

Asked by

To ask His Majesty’s Government how they will respond to the finding in the Health Foundation report Delayed discharges from hospital: comparing performance this year and last, published on 14 December 2025, that the number of beds occupied by people who are medically fit to leave hospital but have nowhere to go is increasing.

My Lords, we know that too many people are delayed leaving hospital. We are determined to tackle this. This winter, we are ensuring that NHS trusts focus on improving in-hospital processes and work with local authorities to tackle the longest delays. We are providing targeted support to the most challenged systems. These efforts are backed by £9 billion through the better care fund, enabling the NHS and local authorities to work together to reduce discharge delays.

I thank my noble friend for that response. Every time we hear about the problem of delayed discharges—and some of us have been working on this for decades—the causes are the same: lack of co-operation and co-ordination between the agencies involved, not just the NHS and social care but the families of patients and the community services provided by the private and voluntary sectors. There are places where discharge procedures work well because all those agencies plan together, not worrying about who is footing the bill or who has the greater responsibility. Does my noble friend agree that, except in cases of emergency admissions, discharge planning should start when the patient is admitted and not wait until they are ready for discharge?

My noble friend is absolutely right. I emphasise her words that we must have an integrated, co-ordinated approach. She is quite right to highlight that some areas are doing this. It has not been straightforward, but dedication and bringing together all the elements that she raises, including health, social care, housing, voluntary and community partners and the families themselves, make the difference. We are focused on making sure that where good practice exists it can develop and that the statutory guidance around planning for discharge before admission is adhered to locally.

My Lords, the Minister will be aware that there is limited capacity in social care in terms of beds and that there are real problems of staff shortages across the NHS and in social care. The noble Baroness, Lady Pitkeathley, mentioned functionality and co-ordination between different agencies, including the NHS, local authorities and social care. As she rightly mentioned, there are blockages—such as receiving medicines et cetera—to patients being discharged from hospital. What key performance indicators are the Government going to put in place to ensure that we remove these blockages rather than just pursuing a generalised way forward?

The noble Baroness raises how we assess performance. That is a valid question. This work has been tackled through all the plans for improvement. It is complicated, as she suggests, and covers a range of different areas. I do not think there is one prescriptive model that we need to adhere to. We need to make sure that it is very clear how benefits come to patients, in particular, when we get the systems right. I am happy to discuss this further with her.

My Lords, bed-blocking—as we refer to it, as opposed to delayed discharges—is a very sensitive issue, for the hospital and the patient. It leads to people waiting in corridors to be treated. Many different ways have been attempted to deal with this: expanding home-based care, utilising spare capacity in care homes, and through adult social care. Talking about adult social care, can the Minister tell us where we are up to on phase 1 of the report by the noble Baroness, Lady Casey, which is meant to be implemented in mid-2026, because that will be a first step towards solving the problem?

The noble Lord raises the important point about the Casey review, which is fundamental. As he knows, it is an independent process, so I cannot give him the exact details that he is looking for, but I can assure him that the noble Baroness, Lady Casey, has been meeting with all the relevant people. We assume she is on track to bring forward the medium-term suggestions for improvement that she has promised us this year.

My Lords, I thank the noble Baroness, Lady Pitkeathley, for raising this issue a number of times over many years to Governments of all colours. The latest acute discharge situation report suggests several reasons for delayed discharges, some of which the noble Baroness mentioned: awaiting medicines to take home, awaiting a discharge letter or other discharge documentation, or awaiting transport. Setting aside some of the more complex cases—people who are homeless or who require specialist treatment—organising transport and medicines in alignment with someone’s discharge date should, in theory, be quite simple once the systems are digitised and share data between them, but for now we hear stories of hours spent on the phone to care homes to find out which ones have space for discharged patients. Given these challenges, how is Minister’s department supporting ICBs to align their systems to reduce these delays caused by both small procedural blockages and digital disconnects, which slow down the whole system and sometimes lead to it being seized up?

I reassure the noble Lord that the Department of Health recognises the issues that he raises. That is why £2 billion is being put into NHS digital transformation to modernise systems, expand the use of electronic patient records and improve productivity across the service. It simply is not good enough that the reasons he outlines are causing delays. We are determined to improve these areas to speed up the process and ensure that people do not fall through the gaps, as we have seen too often.

My Lords, the report in the Question is most welcome, but I am sad to say that it is the latest in a long line of similar reports, all recognising that the NHS will continue to be at risk until social care is sorted out, not least because the NHS is free at the point of delivery whereas social care is means-tested. When will the Government—of any kind—agree to tackle this issue of social care? It is serious and will get worse.

The noble Lord raises the importance of the Casey review, but we are not standing still waiting for the noble Baroness, Lady Casey, to report. We are making progress towards building a national care service, with around £4.6 billion of additional funding available for adult social care by 2028-29 compared with 2025-26. All of us in this Chamber know how important improving social care is. We are not going to improve the system until we move forward on this and make sure that we get the best services for our frail and elderly in particular.

My Lords, it is true that this is a very long-standing problem. When I was Health Minister, I spent quite a lot of time looking at how we could improve the services. The multi-disciplinary team was key, but the other key element, which this report highlights, is getting assessments done early, particularly of the home, to ascertain what specialist equipment is needed and get it installed. Can my noble friend the Minister take up the issue of good practice in that respect, and look at where those early assessments have been particularly effective and how we can spread that best practice?

I am grateful to my noble friend. I am particularly grateful as I was very active in Leeds, which has a practice going far back that is recognised as one of the foremost in the country in terms of the Home First model. I am delighted to say that it has been picked up by others. Bringing together all the agencies that we have discussed before helps in that process. The early indications are good: a 28% reduction in length of stay and a 7.1-day reduction in rehab. All those elements are critical. It is possible to do this, and we need to replicate good practice wherever we find it.

I am grateful to the Minister for allowing me in at the end. She has mentioned the independent commission of the noble Baroness, Lady Casey of Blackstock. I may be the only Member of your Lordships’ House who is somewhat surprised to know that the noble Baroness is the only commissioner on this independent commission; there are no others. Given that her name is once again being linked with some vacancies arising at the centre of government, could the Government perhaps appoint some more commissioners to make sure that the independent commission is a bit more resilient?

I always look forward to the noble Lord’s questions. I do not think I have an answer to his question at this moment in time, other than to say that the noble Baroness, Lady Casey, is absolutely determined and committed to this work, and we will do everything we can to support her in it.