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Hospital discharge funding in England comes with strings attached, says King‘s Fund report

One-off payments to reduce delayed hospital discharge ‘come with insufficient advance notice for effective planning’, forcing providers to resort to short-notice residential care rather than supporting patients at home, a new King’s Fund report has found.

The report, ’Hospital discharge funds: experiences of winter 2022-23’, looked in-depth at six health and care systems. The authors spoke to local authorities, integrated care system leads, acute trusts, Healthwatch and local care provider associations.

Commissioners and providers across each area ‘strongly criticised burdensome monitoring requirements’ and said funding was rarely available to prevent hospital admissions.

Areas did manage to use the funding to put services in place and support social care, but ‘were not confident they were spending funding as effectively as possible’.

The funding in question was provided in two tranches: the Adult Social Care Discharge Fund of £500m from the Department of Health and Social Care, and a further hospital discharge fund of £250m from NHS England. Each had different conditions, which were not known in advance, authors pointed out.

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The report found that the six sites ‘did not all have a shared understanding of local causes of delayed discharges’ or ‘priorities for action’. Authors heard of more than 20 reasons for delayed discharge, although lack of staffing was a consistent theme.

The report also highlighted NHS England data which found that although many more patients were discharged home simply – seen in 85% of cases – compared with the predicted 50%. In addition, three times more patients needed 24-hour bed-based care on discharge (3%) compared with the predicted 1%.

Delayed hospital discharge a ’longstanding problem’

Simon Bottery, a senior fellow at the King’s Fund and co-author on the report, said: ’Delayed hospital discharge is a widespread and longstanding problem that affects thousands of patients, their families and loved ones. The underlying reasons for delays are often complex and vary between local systems, though workforce issues are often at the root of them.’

He added: ’Our analysis makes clear that the Department of Health and Social Care should only use short-term, ring-fenced funding on an exceptional basis and should ensure sufficient notice to sites so that they can plan for it. It’s welcome that this has been largely done for 2023/24 and 2024/25.

’It’s also clear that places should invest effort in developing shared understanding of discharge performance, the causes of delays and the priorities for action to tackle them, as we found that these were often lacking between system partners.’