In a statement in Parliament yesterday (9 January), Health and Social Care Secretary Steve Barclay outlined measures to address the pressures facing the NHS over winter, including long waits for emergency care and delays to discharging patients who are healthy enough to leave hospital. Six areas will trial innovative solutions to free up hospital beds, with the hope that these could be rolled out across the NHS if successful.

Sussex Health and Care, the Northern Care Alliance, Humber and North Yorkshire, One Croydon Alliance, Leeds Health and Care Partnership and Warwickshire Place have all put forward ideas aiming to help patients in their area move out of hospital more quickly while providing continuity of care. Ideas include dedicated dementia hubs, enhanced provision for rehabilitative care, and creating effective data tools to help manage demand for discharge of medically fit patients.

One area, Leeds, is looking to improve how health teams in local hospitals are working with those providing community services such as rehabilitation, which it hopes will result in better support locally for patients who need assistance after a hospital stay. And in the county of Warwickshire, a partnership is being trialled between the NHS and social care to provide care and support for patients when they’re released from hospital into the community, increasing capacity for home care, and expanding recruitment.

Prolonged hospital stays can contribute to poorer outcomes, particularly for older people, with increased muscle loss making rehabilitation harder, while there is ongoing risk of exposure to infections, too, and an impact on mental health. Delays also have a knock-on impact for other people, including those awaiting elective care and those needing urgent medical treatment.

In addition, the Government is making available up to £200 million of funding to buy immediate short-term care placements to allow people to be discharged safely from hospitals into the community, where they will receive the care they need to recover before returning to their homes.

The move aims to free up hospital beds so people can be admitted more quickly from A&E to wards, reducing pressure on emergency departments and speeding up ambulance handovers. There are currently around 13,000 people occupying hospital beds in England who are fit to be discharged.

The additional £200 million – on top of a £500 million Adult Social Care Discharge Fund previously announced – will fund maximum four-week stays for patients until the end of March. Integrated care boards, which arrange health services in each local area, will begin booking beds most suitable for patients’ needs.

Ambulance hubs and discharge lounges

Ambulance queues in some areas are made worse owing to a lack of physical space. A further £50 million in capital funding will go towards the creation of new ambulance hubs, where vehicles can manoeuvre more easily to avoid delays handing over patients. It will also help expand discharge lounges in NHS trusts – areas where patients can be moved out of acute beds while they wait to be discharged, freeing up beds in the meantime.

Health and Social Care Secretary Steve Barclay said: “I’m taking urgent action to reduce pressure on the health service, including investing an additional £200 million to enable the NHS to immediately buy up beds in the community to safely discharge thousands of patients from hospital and free up hospital capacity, on top of the £500 million we’ve already invested to tackle this issue.

“In addition, we’re trialling six ‘National Discharge Frontrunners’ – innovative, quick solutions, which could reduce discharge delays, moving patients from hospital to home more quickly.”

Minister for Care Helen Whately added: “As well as helping people right now, we’re looking ahead to make our health and care system work better next winter and beyond. These problems are not new but now is the time to fix them for the future.”

Other measures already underway include the rollout of virtual wards across England, as part of plans to deliver the equivalent of 7000 more beds using a mix of hospital and virtual wards. The NHS wants to set up 40 to 50 virtual beds per 100,000 population by 2024. Virtual wards will enable people who, for example, have acute respiratory infections, to be treated at home with telemedicine or pulse oximeters.

Sarah-Jane Marsh, national director of urgent and emergency care, said: “We want to ensure all patients ready to leave hospital do so quickly and safely, and NHS staff are working closely with local authority colleagues to help get more patients out of hospital when they’re medically fit to do so.

“We hope the frontrunner programme will offer new solutions for local systems to help patients access the services they need and help free up bed space in NHS hospitals.”

Restructuring and funding questions

Responding to the Health Secretary’s announcement, NHS Providers’ interim chief executive Saffron Cordery said: “We look forward to seeing the innovations being explored by the ‘Discharge Frontrunners’ to free up more hospital beds alongside the work being done by trusts and their social care colleagues, who will be working hard to ensure any intermediary care offered supports people appropriately.”

However, she also warned that clarity is needed over what happens when this funding runs out in March.

She continued: “And while an extra £50m in capital funding to expand hospital discharge lounges and ambulance hubs to minimise delays handing over patients sounds good in theory, questions will rightly be asked about how quickly and efficiently the NHS estate can be restructured to implement these changes given the pressures we are being confronted with right now.

“Trusts will also be seeking urgent reassurances that they will be given the freedom and flexibility to spend this capital funding on innovations and priorities locally to help best minimise handover delays.”

Matthew Taylor, chief executive of the NHS Confederation, also expressed caution: “NHS leaders welcome the £250 million of funding to support discharge of medically fit patients and expand emergency department capacity, but the reality is we’ve been warning about this winter since the summer and, in order to be put to best possible use, healthcare leaders planning and running services in local communities needed this money months ago.

“NHS leaders will also be pleased to hear that the Secretary of State recognises the need for the right wraparound care for those being discharged from hospital but after over a decade of austerity neither the social care sector nor the Government are in any position to ensure it.”