PATIENTS who were well enough to leave hospitals in Swansea and Neath Port Talbot were stuck in them for nearly 65,000 days in 2023-24, a report said.
The main reason for the delayed discharges were waits for assessment by social services staff, or by social services staff together with health professionals.
Other causes included delays in arranging home care and a lack of residential care home capacity.
This is a long-standing issue for health boards, which run hospitals, and councils, which arrange home care and residential care, and leads to patients losing mobility and strength while waiting in hospital beds – a process known as de-conditioning.
It has knock-on effects too for emergency departments and ambulance services because it’s harder to admit new patients promptly when there are fewer free beds. In addition, some planned operations have to be postponed.
A report by Audit Wales looked at the arrangements in the West Glamorgan region – or Swansea and Neath Port Talbot – and found around 232 patients per month in the first half of 2023-24 were medically fit but unable to leave hospital.
Audit Wales said this equated to 64,975 lost bed days throughout 2023-24, costing just under £32.5m. It meant nearly a fifth of all hospital beds were occupied by people who didn’t need to be in them.
The report said: “The resulting impact on the timeliness of access to urgent and emergency care services is significant with ambulance handovers and waiting times in the main emergency department some of the worst in Wales.”
It added: “Overall, we found that while partners understand and show a commitment to improving patient flow out of hospital, performance remains extremely challenging.”
The report made seven recommendations which have been accepted by the health and council bodies involved. Audit Wales has also been examining discharge arrangements in other areas of the country.
The report said access to long-term care home beds in Neath Port Talbot was “problematic” and the county had the highest rate of delayed discharges in all of Wales per head of population. Swansea was fourth highest.
But it added that waits for packages of home care, also known as domiciliary care, were improving in both counties.
Referring to the discharge process itself, Audit Wales found an “overcautious” approach and “culture of risk aversion”. It said: “Whilst staff may be acting out of kindness, they may not be acting in a patient’s best interest.”
The report said there was also frustration from social workers that some health staff were giving patients “unrealistic expectations” about the level of care they could expect when they returned home. It added that not enough patients were being discharged at weekends.
Actions being taken to address these issues include the creation of an integrated discharge hub at Morriston Hospital last July to help get more patients out of hospital in a coordinated way.
The hub, said Audit Wales, had shown signs of success and been rolled out to Singleton Hospital and Neath Port Talbot Hospital.
Joint initiatives to improve patient flow out of hospital are mainly delivered through a group called the West Glamorgan regional partnership board comprising of the health board, councils, and third sector and citizen representatives.
During a discussion about Audit Wales’ report at a Swansea Council committee meeting, Cllr Jeff Jones asked what other regions were doing better than Swansea and Neath Port Talbot at getting patients out of hospital.
Anne Beegan, of Audit Wales, said some of the recommendations also applied to other regions and that it was more a question of nuance. She added, however, that Cardiff and Vale University Health Board had invested a lot in “step-down” provision – community beds to help people build up strength before going home – and that it had one of the lowest rates of delayed discharges in Wales.
Ms Beegan said health boards were monitored about their level of delays by the Welsh Government and could be made subject to increased intervention.
Cllr Mike Lewis asked if IT systems used by the NHS were incompatible with those of councils and whether this was causing delays if so. Ms Beegan said she thought they were incompatible at the moment and there was “a communication barrier” as a result but not necessarily delays.
Audit Wales’ recommendations included increasing weekend hospital discharges and better information sharing.
Cllr Lesley Walton asked why representatives from social services weren’t present at the audit and governance committee meeting to give their perspective on the report, which was published in March.
The meeting heard the staff concerned were on annual leave but the committee could invite them to a future meeting.
“I think it’s absolutely essential,” said Cllr Walton.
