THE LONG GOODBYE
Can the seemingly intractable problem of delayed hospital patient discharge be solved by the creation of a single responsible body?
By Norman Niven
CEO at The Medication Support Company and former Director at BUPA
What seems to be the problem?
Perhaps the biggest challenge facing the NHS is greater numbers of patients experiencing delayed discharge from hospital, meaning they are medically fit to leave but are unable to do so.
The impact of delays is especially acute when waiting lists are rising, A&E departments are overstretched, and the winter flu season is upon us. And because there are fewer available beds, planned procedures are also impacted.
Finally, there are many risks associated with longer stays; hospital-acquired infections, blood clots, muscle weakening, and pressure sores – to name a few.
While most will be discharged to their home, many require more formal support, often requiring resources from the social care sector – but here too there are pressures – growing demand, staff shortages, and under investment.
The NHS often cites lack of social care capacity as the primary reason for delayed discharge – but the problems run much deeper. It is a complex, disjointed process, exacerbated by a lack of resources, poor communication, confusing financial channels, and fragmented systems.
What can be done?
Here, we break down the various components of the system to see where responsibility lies, how funding works (or doesn’t), and examine the roles of the many players in this tangled ecosystem.
Could the answer be a single body with the sole responsibility for handling every aspect of the discharge process, and with a single source of funding that covers all the cost areas?
But, firstly, what is the scale and nature of the problem?
Stand by your beds
According to a piece on the Nuffield Trust website, from September last year, “The total number of patients who were ready to leave hospital but were delayed has increased by 43% from an average of 8,545 patients per day in June 2021 to 9,933 patients per day in June 2025. At its peak, in January 2024, there were 14,096 patients delayed in hospital.”
When a patient is medically fit but cannot leave, the reasons are classified as:
- Hospital Process: Issues within the hospital’s control, such as awaiting medications, final tests, or transport.
- Wellbeing Concerns: Concerns from the patient or family about safety, or delays in assessing mental capacity.
- Care Transfer Hub Process: Delays in identifying the appropriate destination or funding.
- Interface Process: Delays in coordinating care with external services (e.g. home care, social care).
- Capacity: Shortages of available spots in community or long-term care beds, or lack of staff to provide home-based support.
As noted in a May 2025 blog on The King’s Fund website, capacity is the most common reason for delayed discharge, and the majority of these cannot be attributed to social care alone.
Who’s in (dis)charge?
Focusing on the relationship between the NHS and social care sector, and digging a little deeper into the systems that most directly impacted patient discharge, we firstly find Integrated Care Systems (ICSs).
ICSs and Integrated Care Boards (ICBS) are part of the NHS structure established by the Health and Care Act 2022. ICSs are the overall partnership, while ICBs are the statutory NHS bodies responsible for managing the budget and commissioning services.
So, for clarity, the body with overall responsibility for patient discharge is the ICB, which acts as the strategic lead, working with local authorities to arrange community support (for example, care packages) to get patients home safely and quickly.
But it’s not working, or at least not well enough, and that’s in part down to a lack of proper funding – or at least inefficient use of existing funding.
According to a July 2025 Blog by Dr Agnes Arnold-Forster on The Health Foundation website, “ICBs are facing cuts of 50% to their running costs.”
On a day-to-day basis, responsibility for discharging lies with a multi-disciplinary team, including the consultant/clinician (medical readiness), the discharge coordinator/case manager (logistics), nurses, social workers, and occupational therapists.
A Care Coordinator often acts as the main contact, bringing together health and social care professionals.
With so many bodies involved it is not surprising to find friction, communication problems, and financial challenges.
Show me the money
Here are the key funding mechanisms around the discharge process:
The Better Care Fund (BCF) combines mandatory contributions from ICBs and local authorities. It is used for joint initiatives, with a significant focus on hospital discharge.
The Hospital Discharge Fund manages funds for ICBs and local authorities to pay for short-term care packages. This funding is now consolidated within the BCF.
Continuing Healthcare is for individuals with a primary health need; ICBs fund the entire health and social care costs, including personal care and accommodation in a care home.
So, there are multiple sources of funds, coming from various sources and channelled through various networks, but the management of all this adds a considerable overhead – and introduces complexity (for which read delays).
In the face of such complexity, the obvious response is to simplify. A single body, single source of funding, and a clear mandate for delivering optimally efficient patient discharge.
The good news is that this can be achieved within the current system, by improving existing mechanisms.
A new hope
Is it possible a new service, based on an equal partnership between the NHS and social care sector, with a direct, single source of funding, and with a mandate to implement best practice for patient discharge, could be the answer?
The key issue is who pays for a discharge service that requires the cooperation of the health and care sector bodies?
In a report by the BBC, Kerrie Allward, who acts as a policy lead for the Association of Directors of Social Services, said; “Councils often lack the funds to invest in integrated services that would support more timely discharge.”
The creation of a single ‘Health and Care Unified Discharge Programme’ could take advantage of the ICBs to define and implement this new service, which would be funded directly by government and have a clear mandate to deliver a single, unified discharge process – with the health and care sectors being equal partners.
This may sound very good in theory, but some hospitals in North West England are already demonstrating what can be achieved with such a unified approach; patient discharge delays and hospital readmissions have been cut significantly.
In this case, the local ICB was not directly involved.
Conclusions
Making changes to a large, complex system is a major challenge, very often leading to unintended consequences.
The NHS is a textbook case; governments seem unable to resist tinkering, and the results of this over the past 50 years have not been encouraging.
The problems with hospital patient discharge serve to expose structural, systemic, issues within the service and the relationship it has with the social care sector.
Yet, simply by shining a light on these issues it is possible to see how existing structures, systems, and processes could be utilised to better deliver optimal patient discharge.
It looks like a tangled mess – one that has emerged by continuous tinkering and interference, short-term thinking, and patched-up solutions – but the undoubtedly exceptional talents in the NHS can be exploited to engineer a new way of working that is simpler, stripped back, made lean.
The new body would be ultimately responsible for ensuring every patient is discharged in a timely manner, to an appropriate destination, with all the necessary support measures in place.
This is necessarily a longer-term solution; it takes time to turn a tanker. But as everyone knows, making the easy choice now only leads to greater pain later – and vice versa.
About The Medication Support Company
The Medication Support Company offers a complete medication management service, from internet-based home communications systems to remotely lockable medicines cabinets.
Our trained and accredited pharmacy technicians can contact people at home to support them with their medication regimes, ensuring the right drugs are taken at the right time, in the right dosage.
This leads to an improvement in population health that ultimately saves time and money for the NHS and local authorities.
