Hospital discharge delays affecting patients seeking urgent treatment – report

Delays in hospital discharges are leading to new patients not being able to access treatment urgently, a watchdog report has said.

The Regulation and Quality Improvement Authority (RQIA) said that workforce challenges dominated all the findings in its report into public and independent health and social care services in the Southern Trust.

Chief executive Briege Donaghy said that the work of the Department of Health in reforming adult social care services across all of Northern Ireland is critical.

The RQIA is the independent body responsible for regulating, inspecting and reviewing the quality and availability of health and social care services.

The Southern Health Trust provides services across the five council areas of Armagh, Banbridge, Craigavon, Dungannon, and Newry and Mourne, and includes the Craigavon area acute hospital.

An inspection was undertaken in autumn 2023 in response to “ongoing and persistent system pressures”, particularly those affecting hospital services.

It looked at patients who were delayed in their discharge from Craigavon Hospital.

The report said: “The inspection found that the system was performing poorly against a full range of established regional targets.

“There were signs that it was not improving, and in some cases continuing to deteriorate, as evidenced by numbers of delayed discharges, ambulance response times, ambulance handover delays, times waiting for admission to a hospital bed and times waiting for triage in ED.

“Performance varies considerably across the week, including in respect of the number of simple discharges from hospital, indicating that despite significant increase in seven-day working, twilight and weekend services, the commissioned funded full seven-day service to facilitate reliable discharges each day remains an aspiration.”

The report said: “Patients must be able to access emergency care when this is needed, and be provided with timely access to the care and support they need in the community, once acute treatment has been completed.

“The inspection adds to the evidence of the harm that is caused when there are delays in patients accessing acute care.

“It shows the impact of delayed discharge on those patients ready to leave acute care, to be supported at home, in a care home setting or other community care.

“The two aspects are very much linked – if patients cannot leave hospital, new patients who need care urgently cannot get access to the acute care they need.”

The report said there was not sufficient capacity, through sufficient staffing, to cope with the number of patients who needed care outside the hospital.

Ms Donaghy said: “The workforce challenge dominated all our findings. All the services we explored needed more staff.

“We know that the working population available in Northern Ireland is not growing in keeping with the growing needs for community care.

“There is a need therefore to create conditions that attract staff to work in, and stay in, health and social care services.

“RQIA considers that the work of the Department of Health in reforming adult social care services, and developing the totality of the health and social care workforce, is absolutely critical.

“This must be coupled with service reform to ensure sufficient capacity in community, social and primary care to meet our population needs – and make effective use of resources.

“Without this, the pressures will continue across the system.”

She added: “These pressures will be most visible in our acute hospitals and ambulance services, and experienced by patients and by our emergency care staff ”.

The report has made 11 recommendations for improvement.