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Hospitals in England are operating at close to full capacity, with patients facing often facing lengthy waits for admission and ambulances stuck outside emergency departments. Seasonal pressures from norovirus, flu, and COVID-19 are exacerbating the situation. 

However, a persistent issue remains the thousands of hospital beds occupied by patients who no longer require acute care but cannot be discharged.

According to National Health Service (NHS) England data from last month, nearly one in seven hospital beds (13,767) were occupied by patients fit for discharge but unable to leave due to systemic delays.

“This logjam, often due to shortages of social or community care, has been a major challenge for years,” noted Saffron Cordery, interim chief executive of NHS Providers.

Care Home Capacity Vs Discharge Failures

Care England, the representative body for providers, maintains that care homes across the country have thousands of vacant beds that could accommodate these patients. It argues that systemic failures in assessment, rehabilitation, and funding are responsible for preventing timely discharge.

Professor Martin Green, Care England’s chief executive, told Medscape News UK: “If you look at the data, there were around 13,000 people requiring discharge. Well, there were about 40,000 empty spaces in social care, not to mention the fact some people would have been able to go home to be cared for.”

Green dismissed the notion that social care lacks capacity: “The real problem is with who is going to commission that service. The NHS don’t want to, and local authorities say they haven’t got the money — and that’s where the logjam is.”

Separate Budgets

One of the main challenges is the separation of NHS and social care budgets. While the government funds the NHS, local authorities are responsible for social care budgets, creating a fragmented system.

Emma Dodsworth, a researcher at the Nuffield Trust, told Medscape News UK: “Social care funding is a mess. Local authorities are under significant financial pressures, many of them are going bankrupt, and the impact of employer national insurance contributions will be a huge additional cost.”

She added: “The blame game between health and social care is particularly unhelpful. Care England are right to say there’s capacity, as data shows capacity at about 85%. But even if providers have capacity, councils and the NHS aren’t always able to pay the fees to cover the higher costs, so some providers just refuse to take those people, which means people are in hospital for longer.”

Complexities of Hospital Discharge

Discharging patients from hospital is complex, with funding pressures, delays to discharge packages, and a lack of suitable placements all contributing to delays.

Every hospital has its own specific challenges, both administrative and financial, according to Dodsworth. “Our analysis shows in around a fifth of the cases of delay, it’s due to hospital processes — issues like signing off discharge letters, creaking IT infrastructure, uncoordinated input,” she noted.

“The Government does recognise there’s also a funding issue related to discharge and has allocated specific funding for integrated care systems and local authorities through the improved Better Care Fund for example,” Dodsworth added.

Social care encompasses care in the home as well as residential care. Analysis by the Nuffield Trust has shown that many patients face delays while waiting for home care, which can involve significant coordination challenges. “Some providers feel local authorities and the NHS don’t know what is available in their local area,” said Dodsworth. “And it is important care services appropriately meet the needs of their population, whether that be specialist care or home care services.”

Need for a Coordinated Approach

Green believes the crisis is solvable but “requires a coordinated approach where social care is recognised as a vital partner in NHS recovery, not just an afterthought.”

He called for enhanced oversight from the Department of Health and Social Care to ensure discharge issues are managed efficiently. “If there’s capacity in a local area, there needs to be some way the department mandates the local integrated care system, the local trust, or, indeed, the local authority to come together and use the money that’s available.” Green said. “But nobody is taking a grip of it at the centre. We need clarity, leadership, and checks and balances in the system to penalise people who don’t do the right thing.”

Green was critical of the current situation: “At the moment, it’s a complete dog’s breakfast,” he said. “It can easily be sorted out by some clear direction from the centre which holds the budget.”

Proposed Solutions: Fixed Tariff and Systemic Reform

Care England has proposed a fixed tariff of between £1500 and £1800 per week for social care providers to take on a patient ready to be discharged.

“The NHS should engage with social care directly, but won’t,” said Green. “We have a new system with integrated care systems (ICSs) and you’d have thought their role would be to allocate money where it’s needed to solve the problem. But those ICSs have done nothing — they are a complete disgrace. I don’t know what the hell they have been doing, and neither does anyone else,” he added.

Dodsworth said: “The role of integrated care systems is exactly as the name suggests, but essentially you have two systems — health and social care — which are organised and funded differently, so integration is still a work in progress.”

Patient Impact of Discharge Delays

Beyond hospital capacity concerns, prolonged hospital stays can lead to poorer patient outcomes, particularly for older people. Extended stays accelerate muscle loss, reduce mobility, and increase the risk of falls, often leaving to a permanent loss of independence.

“We urgently need a long-term solution that addresses this complex problem, including an expansion of capacity in social, community, and home care alongside investment in rehabilitation and intermediate care to help people stay independent and reduce avoidable admissions,” said Cordery.

Dodsworth concluded: “There’s not a simple answer. Issues around a lack of long-term funding prevents thinking of a sustainable solution. The ambition is there, but blame between the two systems creates friction, which stifles progress. Remembering that care should be patient centred is surely the most important thing.”

NHS England and the Department of Health and Social Care have been approached for comment.

Siobhan Harris is an experienced health, medical and news journalist. She works in broadcast media and online.