Delayed discharge costs NHS Scotland £440m a year

Delayed discharge saw ‘fit’ patients spend an extra 720,000 days in hospital in 2024-25.

Watchdogs say the issue – which sees patients deemed well enough for discharge remain in hospital – is “a symptom of wider pressures across health and social care”, with the unnecessary hospital days costing the NHS an estimated £440m a year.

But the full financial impact is not known and while projects are underway to tackle the problem, a “lack of evaluation” means it is unclear which is having the biggest impact, and whether they are delivering value for money.

In a joint report today, the Auditor General for Scotland and the Accounts Commission are calling for action from the Scottish Government.

The SNP administration has made reducing delayed discharge a priority matter, but a backlog remains, with the older patients disproportionately affected.

One in nine hospital beds were lost to the problem over the period.

Stephen Boyle, Auditor General for Scotland, said: “Delayed discharges from hospital have far-reaching impacts on people’s health and well-being. The Scottish Government, health bodies, councils and other partner organisations agree on the need for major changes and are actively trying to reduce delayed discharges.

“Now they must improve how they collect, analyse and use data to evaluate the initiatives underway to tackle the problem. Without this, it’s impossible to understand the impacts and costs of delayed discharges and whether the initiatives across Scotland are improving lives, services and delivering value for money.”

Malcolm Bell of the Accounts Commission commented: “Significant change is critical across our health and social care services, shifting towards preventative care, greater use of technology and ongoing investment in the workforce. Without this, the care and support individuals need to leave hospital won’t always be available.”

Welcoming the report, geriatrician Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said the long-standing problem has intensified: “Delayed discharges have existed in the NHS in Scotland for decades, pre-dating the current government’s tenure, but have become more visible in our acute hospitals as the capacity in ‘downstream’ non-acute NHS facilities has been progressively reduced. The ageing of our population is a societal triumph, but our failure to provide integrated health and social care for that population risks turning that triumph into a disaster.”

Scottish Conservative health spokesperson Dr Sandesh Gulhane said: “Delayed discharge also has a catastrophic domino effect on our NHS, causing last-minute cancelled operations and huge backlogs in A&E departments.

“The SNP squandered £30m on a doomed National Care Service and have no solution to the crisis in social care that lies at the root of the problem. They should adopt the Scottish Conservatives’ Fast Track to Care policy, which would guarantee patients are moved into care homes within 48 hours of being declared fit for discharge. Our plan would deliver up to 600 short-term care home beds in pilot areas and provide extra funding for councils that step up.”

Scottish Lib Dem leader Alex Cole-Hamilton called the costs “utterly astonishing”, saying: “The SNP's abject failure to provide proper care at home or in the community is leaving 2,000 patients stuck in hospital on a typical night. It’s why A&E departments are struggling to move people into hospital and why ambulances are stacking up outside.”

Meanwhile, Scottish Labour deputy leader Jackie Baillie said: “We have previously called for the Scottish Government to make greater use of technology and to invest in the health and social care workforce, yet SNP ministers are failing to take any responsibility.”

Health Secretary Neil Gray said the government agrees that “more must be done to ensure people receive the care they need in the right place, at the right time” and steps are being taken to respond to the concerns raised.

He said: “Despite the challenges the report sets out, there have been improvements in some areas delivered through a whole-system approach to change and 97 per cent of all hospital discharges happen without delay.

“Local systems have been working hard to reduce delays and deliver on the commitments set out in our Operational Improvement Plan, supported by investment of over £220m to improve patient flow, enhance capacity and remove blockages keeping patients in hospital longer than necessary. This winter, that includes up to £20m to fund increased social care and reduce pressure on the hospital front door.”