Study: 70% of nurses in Scotland lack confidence in new delayed discharge target in hospitals

As the Scottish Government prepares to introduce a new two-week discharge target in hospitals from 1^st April 2015, a new study has found 70 per cent of nurses in Scotland lack confidence in the policy and do not believe it will help reduce delays.

The findings, from older people’s charity the Royal Voluntary Service reveal the pressures currently faced by NHS nurses in Scotland. Two thirds of nurses (66%) state lack of social care as the biggest cause of delayed discharge and over half (52%) admit they are frequently forced to delay discharging older patients because there is no support in place for them after hospital.

The study, assisted by The King’s Fund, forms part of a campaign “Let’s End Going Home Alone”, which sees the charity work in partnership with communities, local authorities and NHS Boards to provide more volunteers in hospitals and support vulnerable older people in their homes following discharge from hospital.

Recent figures reveal the number of A&E patients in Scotland seen within four-hours is almost 10 per cent below target, and over 1,200 beds a day were unavailable to new patients in December 2014. The Scottish Government is committed to reducing the number of people in Scotland waiting to move from hospital to a more appropriate care setting, and from 1^st April 2015 the current target of four weeks will be reduced to 14 days to address the issue.

The care crisis has reached such a level that nurses in Scotland are finding that over a third (37%) of older patients are in fact medically fit for discharge, but instead are languishing in much needed beds because there is no post-hospital support in place.

Over three quarters of the Scottish nurses surveyed (84%) reported that delayed discharge is a serious problem in the hospitals they work in and 76 per cent said it has worsened in the last 12 months.

The study found that as well as social care and in-hospital delays, families of older people anxious for them to stay in hospital for longer are also exacerbating the issue. Over half of Scottish nurses (54%) are frequently pressured by relatives to keep patients in hospital, despite them being physically well enough to leave.

Changes in family structures and circumstances, such as divorce and relocation, raises concerns about the availability of family support for older people, and over three quarters of Scottish nurses (76%) say greater family displacement is having an effect on how quickly they can be discharged.

However, while 72 per cent of nurses in Scotland feel families need to take more responsibility for their older relatives, over three quarters (78%) do not believe they should be blamed if there is not enough support in place.

Nurses in Scotland believe a good relationship between the NHS and social care is most important to a successful discharge policy (86%). Overall, almost two thirds (64%) believe partnering with charities and volunteers would help ease pressure on the NHS.

On 1^st April 2015, NHS and social care partnerships across Scotland will submit plans on how they will integrate health and local authority social care services, to be implemented by 1^st April 2016.

Margaret Paterson, Director of Royal Voluntary Service in Scotland said:

There have never been so many delays in hospital discharge and this is primarily due to a lack of support in place for older people after hospital. The recent boost to the Integrated Care Fund is certainly a step in the right direction, however, many local authorities and hospital boards are still struggling with overstretched resources.

Bringing in additional volunteers through Home from Hospital schemes is a cost effective solution to ensuring older patients experience a timely and well-managed discharge from the hospital ward. A volunteer can offer both practical and emotional support and help the older person to rebuild their confidence and go on to live an independent and fulfilling life.

David Buck, Senior Fellow, Public health and health inequalities, at The King’s Fund said:

Across the UK delayed discharges are a key indicator of the performance of not only hospitals, but how our overall health and care systems are working. In recent months, this has become a key concern for health and care systems across the country.

Volunteers can help ease some of this pressure by working with hospitals and social care to help improve transfer of elderly people to their homes. We know that those who receive these services value them highly and there are indications that this may also help reduce readmission rates too.

As part of the campaign, the Royal Voluntary Service has developed the Six Essentials it believes every older person should be entitled to experience when they leave hospital:

1. Every older person should be told the plan for their return from the hospital
2. Every person should be accompanied home before 10pm from hospital unless their preference is different
3. Every older person needs to be able to collect their prescriptions and get to follow up appointments for a speedy recovery after a stay in hospital
4. Every older person should come home from a hospital to a warm, well-lit house with someone asking how they are
5. Every older person should know they’ll have help to get some shopping in and won’t have to sit hungry after a stay in a hospital
6. Every older person should have a friendly face to turn to for help after a stay in hospital