Delayed hospital discharges began to increase across Lancashire towards the end of last year, after almost twelve months of solid improvement.
Figures presented to a meeting of the county’s health and wellbeing board revealed that delays had risen above a nationally-set target in in each of the three months up to November, the latest point at which data is available. It continued an upward trend which began towards the end of the summer and was previously attributed to increased admissions caused by the 2018 heatwave.
But the onset of colder weather actually saw a sharper increase in the number of so-called “delayed days” - the total amount of time spent in hospital by patients when they have been deemed medically fit to leave.
By November, the figure stood at 3,434 days - almost 400 above the target, but still more than a thousand days fewer than at the same point in 2017. The statistics exclude the standalone council areas of Blackpool and Blackburn.
Delays are attributed either to the NHS - for not discharging patients in a timely way - or to local authorities, for failing to carry out assessments and arrange suitable care packages to support them.
Historically, social care accounted for the majority of the delays, but Lancashire County Council’s share of the hospital hold-ups more than halved in the twelve months up to September 2017. NHS trusts’ contribution to delays is now more than double that of the local authority, accounting for two thirds of the overall total.
“We need to keep an eye on this, because there has been a lot of investment [in reducing delays], Paul Robinson, Lancashire’s Better Care Fund manager told board members.
“There is much more volatility in NHS delays [and] performance appears to be worse in Central Lancashire.”
The meeting heard that reablement services - which help people to regain their independence after a stay in hospital - were working better in the east of the county. It was in those districts that the Home First scheme was initially launched, designed to get patients home on the first day they were fit to be discharged - and give them the intensive support which they may need to stay there.
The programme has now been rolled out to all corners of the county, but the meeting heard that there was concern within the NHS about the “sustainability” of such services as it awaits funding allocations for the next financial year.
The Improved Better Care Fund saw Lancashire handed £46m between 2017 and 2019 to design ways of reducing hospital discharge delays and better integrating health and social care.
The future of that scheme - and a sister project which pools a portion of NHS and local authority budgets - has not yet been laid out by the government.
Mr Robinson told members that “integration is not going away”, but the way in which it is funded may yet change.
Elsewhere, the meeting heard that the county was performing better than target on other measures, including the number of emergency admissions - which stood at 40,133 in the second quarter of 2017. The number of older people admitted into nursing or residential care also remained below a maximum target - but papers revealed that performance had "flattened" over the last two years.