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Information disjoint keeps old people in hospital



NAO says health and social care need to share information more effectively to speed up patient discharge

Shortcomings in information sharing between health and social care organisations are contributing to delays in discharging older patients from hospital, according to the National Audit Office (NAO).

Its new report on the issue identifies it as a significant problem for the NHS in England, costing about £820 million per year and having negative effects on the wellbeing of patients.

Data cited by the NAO indicates that there has been an increase of 270,000 days (31%) to 1.5 million in acute hospitals for patients over 65 whose discharge has been unnecessarily delayed. It says this is probably an under-estimate as it only accounts for when a clinician has said a patient is ready for discharge, and that a more accurate figure is about 2.7 million days.

In identifying the reasons for the problem, the NAO says that while health and social care organisations now have a statutory duty to share patient information, its survey showed this does not yet happen routinely.

For example, only a quarter of hospitals said they had sufficient access to primary, community and social care information for most older patients. It heard of examples where the lack of information could result in A&E clinicians being less able to undertake a full assessment and more likely to admit an older patient.

One of its recommendations is that NHS England, working with local government, should set out how health and social care staff can better share information on the circumstances of older people.

Standards ambition

The report was published shortly after representatives of the Health and Social Care Information Centre told the Association of Directors of Adult Social Care conference on informatics that it is examining the information flows between the two sides and aims to develop relevant standards.

Earlier this year, the Carter Review highlighted bed blocking as a major hindrance to operational efficiency in the NHS.

Other reasons for the discharge delays cited by the NAO include a lack of financial incentives for hospitals to speed up the process, staff shortfalls for nursing and home care, and the mixed effectiveness of NHS England’s system resilience groups that plan and coordinate health and social care.

Amyas Morse, head of the National Audit Office, said: “The number of delayed transfers has been increasing at an alarming rate but does not capture the true extent of older people who should not be in hospital. While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there.

“Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.”

Image by Leon Brooks, public domain via Wikimedia Commons

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