What is it?
The phrases ‘delayed discharge’ from the hospital and ‘patients that no longer meet criteria to reside’ are frequently used in relation to hospital problems. Both refer to patients who are well enough to leave the hospital but have not yet been discharged.
How big is the problem?
Since July 2022, the number of patients in this situation has hovered around 12,000 to 13,000, and the latest figures from January 2025 show that it was up to around 14,000 each week for much of the month. In December 2024, 86.7% of patients were discharged when they should have been, but 13.3% were not, leading to 272,283 bed days lost.
Delayed discharge of patients has major adverse effects on all other areas of the healthcare system, including increasing crowding in A&E, longer handover times for ambulances, and a lack of beds for elective care. Unnecessary long hospital stays are also detrimental to patient health, mental and emotional well-being, and independence. Reducing the number of patients in this position has been a major priority for recent governments and a target for integrated care boards (ICBs).
Why are people not discharged on time?
Most hospital inpatients will be discharged home without any additional support. However, a minority will require additional support, particularly those with multiple conditions, the elderly, and the vulnerable. This support may be at home, a short-term bed in a care home, or a permanent bed in a care home. It is this group of patients that comprises those with delayed discharge.
The reasons for the increased number of delayed discharge patients are multiple, including over a decade of inadequate funding for the NHS, public health and social care. In addition, the UK population has become more unhealthy, and patient complexity has increased over the past decade. In February 2025, The Lancet published data showing that life expectancy improvement is stalling across Europe, with England experiencing the most significant slowdown. The problem was blamed on poor diet, mass inactivity and increasing obesity. The problem of complex patients is not going away any time soon.
Organising the discharge of these patients can be complex. Good communication between multiple agencies is needed, including various council departments, such as social care and housing, private care homes, and home care agencies. It also requires communication and discussion with the patients and their relatives.
One way to handle the complexity of the situation is to establish care discharge hubs to coordinate communication between all parties. These hubs have been established across England at the hospital trust or ICS level.
What parts of the system are causing the delays?
Much of the blame for delayed discharge has been attributed to problems with social care services, but details have been lacking in the public domain. Since early June 2024, however, it has been possible to more accurately understand why discharge delays have occurred, at least for patients whose discharge has been delayed 14 days or more.
Acute trusts now submit daily data on reasons for delays to NHS England, which is published. The data is divided into the following primary areas: hospital processes, care transfer hub processes, interface processes (referring to NHS trusts and system partners discussing patients’ onward care), patient well-being, and service capacity outside the hospital.
The most recent data for January 2025 shows capacity issues as the primary reason for delayed discharge in 32.8% of cases (3,218 patients), followed by ‘interface processes’ at 28.2% (2,609 patients) and ‘hospital processes’ at 20.4% (1,884 patients). The two remaining categories, ‘care transfer hub processes’ and ‘wellbeing concerns’, accounted for 13.4% (1,243 patients) and 5.1% (474 patients), respectively, of delayed discharges.
The leading issues for patients who had already been in hospital 14 days after their discharge date concerned ‘bed-based rehabilitation, reablement or recovery services’ which were either unavailable (capacity issue affecting 962 patients), or arrangements were still underway (interface issue affecting 622 patients). A related problem was ‘residential/nursing home care not yet available’ a capacity issue with 735 patients. In the care transfer hub processes area the major issue was ‘waiting for confirmation of immediate needs’ which affected 846 patients.
The data submitted by the acute trusts for January at least indicates that a lack of capacity in social care, primarily bed-based and home-based care, is a major issue responsible for 32.8% of delayed discharge in January 2025. However, when the NHS-based processes – hospital-based and care transfer hub – are added together, they are responsible for 33.8%, almost as much. Interface issues are responsible for 28.2% of delays for issues. These delays generally revolve around NHS trusts and system partners spending too long negotiating or discussing“ patients’ care on discharge and so can be attributed to all involved.
What approaches have been taken to tackle delayed discharge
Tackling delayed discharge was a target for previous governments. The Conservative government included the “Ageing Well” money in the 2019 ten-year plan designed to address a mix of factors that cause problems discharging patients from hospitals, including difficulties accessing other NHS services in the community and poor hospital processes.
£647 million was earmarked between 2020 and 2024 to expand community-based services for older and frail people. These services included faster access to rehabilitation care on discharge, personalised care and support at home, and urgent crisis response. The Ageing Well programme was supposed to help local providers hire staff and create infrastructure.
More money was found in September 2022, when the then government announced a £500m adult social care discharge fund, followed in January 2023, by the promise of an additional £200m for extra beds in care homes and other settings to speed up hospital discharge.
Considerable investment has been made in setting up the Care Transfer hubs to aid coordination.
Why haven’t the numbers of delayed discharges gone down?
Policy failure
Despite the promises of money from the Conservative government, much of it never materialised. In October 2024, HSJ reported that the Ageing Well money never fully materialised and little was achieved due to NHS England cutting £390m (70%) from the original budget for improving community care for older people in the past two years.
One former NHSE clinical director told the HSJ that the fact the Ageing Well plans, “were largely defunded and badly implemented must now be a source of national shame”.
The funding cuts meant that the NHS’s long-term plan proposals for a “two-day response standard” to speed up discharge and “proactive care” to prevent admissions among frail and elderly people were never rolled out.
Virtual wards were the centrepiece of the Conservative government’s delivery plan for recovering urgent and emergency care services, announced by the Department of Health and Social Care in February 2023 and again in July 2023, in plans to avert the winter crisis. However, their impact has been limited, and the expansion was slowed by the ending of ring-fenced funding in March 2024.
The current high levels of delayed discharge are having a major impact on other services this winter. The first set of data for the 2024/25 winter, released in December 2024, shows that ambulance handover times have nearly doubled compared to the same time in 2023.
Lack of care home capacity
In previous years, the NHS commissioned capacity for winter from private care homes and homecare from private companies. The January delayed discharge data indicates that lack of capacity in care homes and home care services is responsible for over a third of delays over 14 days.
Yet this winter, the commissioning of care beds does not appear to have happened; HSJ reported in December 2024 that two of the UK’s largest care providers, Barchester Healthcare and HC-One, have said that the NHS has commissioned just a fraction of the “winter pressures” beds from them that they usually do. This is even though the number of delayed discharges is still high.
The HSJ also reported that NHS leaders say the reason for the lack of contracting is that the NHS does not have the funds to purchase the usual number of winter beds, rather than that the service did not need as many as in recent years.
Care in patient’s homes
The lack of funds has impacted domiciliary care providers, and according to Jane Townson, chief executive of the Homecare Association, homecare providers have available capacity, but ICBs are unwilling to pay rates that mean staff are paid at legal rates (national minimum wage), and care is of a high standard instead looking for the lowest price. In a press release in late December, Towson accused some ICBs of “unethical commissioning practices” saying that
“The approach of the NHS to commissioning homecare is nothing short of scandalous…They expect homecare providers to operate below cost, putting both care workers and older and disabled people at risk. The NHS should be concerned about the safety and well-being of those receiving and giving care and support, but all they’re bothered about is saving money.”
Apart from the ongoing development of ‘care transfer hubs’ encouraged by NHS England, there appear to be few central initiatives for reducing delayed care, with the ICBs having to solve the problem with what funding they have.
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