Scotland’s medical royal colleges and Scottish Care have joined forces in a call for action to address the pressures faced by hospitals and care homes which they say are contributing to ‘record’ delays in discharge from hospital.

This week Public Health Scotland has revealed that levels of delayed discharge from hospital reached a record high in August.

It also published the annual Care Home Census, which captures the number of care homes and people living in them, showing nearly one in five homes have closed since 2014.

The Royal College of Physicians Edinburgh says looking across these figures should be a source of “huge alarm”.

Meanwhile, the Royal College of Emergency Medicine (RCEM) Scotland says that care home places must match the need for social care if emergency departments are not to be paralysed patients waiting to leave hospital.

The August 2024 data shows over 2,000 people were waiting to be discharged in Scotland’s hospitals, with the number of days spent waiting when they no longer needed to be in hospital rising by 11% from 2023.

The Care Home Census revealed there were 1,020 care homes for adults this year – 18% fewer than a decade ago despite increased need.

The body representing care home providers says many more are struggling to stay open.

Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said this is particularly concerning heading into another winter:

“As we move closer to another Scottish winter, when pressure on access to and flow through our acute hospital beds will rise substantially, the latest figures on delayed discharges are a source of huge alarm.  

“We are doing a great disservice to those people whose discharge from hospital is delayed, and a further disservice to those who will have to wait to get into hospital beds that cannot be freed for their use. If we can’t get people out of our hospitals we will struggle to get others in.

“We again call for appropriate levels of funding to maximise availability of both “interim” and long-term care home placement and urgent review of those parts of the adults with incapacity legislation that prevent some people from moving from health facilities to social care facilities in a timely manner.

“It is difficult not to link the rising numbers of delayed discharges with the falling number of care home places evidenced in PHS’ report.

“The combined care capacity across the health and social sectors is critical to good flow and timely treatment – the rising numbers of delayed discharges tell us that whole system capacity is inadequate.”

Emergency departments paralysed

Dr John-Paul Loughrey, Vice President (Scotland) RCEM, added that these figures reveal the scale of the issue “in black and white”:

“While the beds they remain in are desperately needed by other people, stuck in Emergency Departments, often in corridors waiting extreme amounts of time to be admitted.

“The system only works when patients can be moved into wards when they need to be, and then out of them again when they are well enough.

“In order for people to get back to their homes, they need adequate social care support.

“Until this is provided, and is available at a scale matching the need, we will continue to see our NHS in paralysis with A&Es dangerously overcrowded, and ambulances queued up outside.

“We need a functioning health and social care system, so the people of Scotland receive the care and support they need when and where they need it.”

Inadequate funding

Dr Donald Macaskill, CEO of Scottish Care, says that the story behind the statistics is “more complex and concerning” than the data suggests as care homes struggle to stay open:

“At a time when there is greater demand than ever before not least as evident in delayed discharge, what we are witnessing is not only a reduction in bed capacity but also a restriction of that availability because care homes cannot afford to open up availability because the resource offered is inadequate.

“Further, the lack of investment over a decade has resulted in a tired and dated physical environment in need of urgent attention but at a time when external funding is scarce and public resourcing inadequate. 

“In addition, the closure of care homes is not uniform across the country but is especially where it has proven impossible to recruit a workforce with the resultant use of agency staff making it very expensive to staff care homes. This is especially in rural and remote areas.”

Last month, the Scottish government and COSLA said they plan to bolster the health and care workforce over winter were met with concern about the lack of funding and resources.

While the latest winter preparedness plan recognised the need to value unpaid carers and include them in decision-making around hospital discharges, Professor Elder says problems will persist without an approach that rewards carers and care staff for the work they do:

“We have previously highlighted the need to value – in the broadest sense of that word – the many paid and informal carers who support older people to go on living in their own homes and those who support older people living in residential and nursing facilities.

“However, without a coherent strategy to support family carers and recruit, retain and adequately remunerate the care workforce, we predict that delayed discharges will continue to rise.”

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