Social care and hospital delays

“There are 24 councils, that account for 50% of the delayed discharges from social care.”

Theresa May, 22 January 2017

There are several ways that delayed discharges from hospital could be counted and, for all of them, the figures quoted seem to be roughly in the right ballpark.

The Department for Health told us that the Prime Minister was referring to the latest figures on all delayed discharges in England which, at the time, were from November 2016.

Around half of all patients who were delayed in being discharged at the end of that month for any reason were to be found in 24 councils.

But that figure includes people who were delayed because of problems with the NHS rather than social care. This made up over half of the delays. If we look just at delays due to social care then the number of councils is slightly lower.

Around half of delayed discharges due to social care were in 20 councils

Last November 2,425 patients had a delayed discharge from hospital at the end of the month because of problems with social care. If you include patients who were delayed because of a problem with social care and the NHS then it comes to 2,958.

Whichever way you look at it about half of them were in 20 councils, out of a total of 152 across England.

You could also add up the total extra days each hospital bed was occupied by these patients. Again, about half were in just 20 councils.

If you look over the whole of 2015/16 it’s a very similar picture. 22 councils made up half of the delays due to social care or a combination of the NHS and social care.

In other words, the issue of delayed discharges due to social care is concentrated in certain parts of the country.

Population plays a role

The picture these figures are painting is that social care delays are hugely disproportionate: so few councils make up so many delayed discharges.

But part of that might just be down to population: the councils bearing the brunt also tend to be the ones with more adults living in them—and more adults over the age of 65. The National Audit Office estimates that around 85% of people delayed in leaving hospital are in this age bracket.

The 20 councils with the most delayed discharges in November account for around a third of England’s over-65s.

You could instead look at councils ordered by their delayed discharges per person.

The King’s Fund health think tank did just that, taking account of each area’s population of over-65s. It found that about 33 local authorities accounted for half of delayed days in November. So a little less disproportionate on this measure.

Counting population size also means some councils don’t look quite as bad in the delays league table. Essex had one of the highest numbers of delayed discharges in 2015/16, but once you consider its relatively large population, it is below the national average.

There are other ways to compare delays around England

The NHS compares the various regions of England based on the average number of patients delayed each day, per 100,000 people living in that region.

By this measure the South West had the most delayed discharges for any reasons in 2015/16. This was followed by the West Midlands and the North West. The North East had the fewest delays.

But if you just look at delays due to social care then there were most delays in the West Midlands followed by the South West and the South East. Once again the North East had the fewest delays.

We’ve looked before at the difference between the best and worst performing councils when it comes to social care and delayed discharges from hospital and how delayed discharges have increased between 2011/12 and 2015/16.

Recording of delays isn’t necessarily reliable

The King’s Fund has also pointed out that “there is an important caveat about the accuracy of these figures. If anything they are likely to underestimate the scale of the overall problem, irrespective of which organisation is responsible… Some of the variations may be due to local differences in how delays are recorded.”