FIGURES were released this week which revealed that there has been a 6% increase in delayed discharges between 2017/18 and 2018/19. The statistic is extremely disappointing, as it means more people who are in hospital when they are well enough to leave.

It is universally acknowledged that hospital is rarely the best place for a patient to be if they are fit for discharge. Prolonged unnecessary stays increase the risk of hospital associated infections and decreased mobility. It can also adversely affect individuals’ independence and personal freedom and cause great distress to them and their families.

Imagine lying in a hospital bed for days, perhaps even weeks longer than you have to, unable to be discharged although you are no longer unwell. I can only imagine how frustrating this experience can be and how badly it can affect someone’s mental wellbeing and morale.

There is considerable variation across the country. My own region, Lothian, is performing the second worst in the country and reported 124,048 delayed discharge days in 2018/19. There are particular pressures in Lothian which have no doubt contributed to this, but we need to ensure that best practice is being shared across the country. On the other end of the scale, East Ayrshire Health and Social Care Partnership has experienced considerable success in reducing the number and duration of delayed discharges. It achieved this by shifting their focus to the needs of the individual patient and reducing the overall time people spent delayed in hospital, rather than the length of individual stays. This model proved that by focusing on more holistic, person-centred care we can reduce the number of days people are needlessly spending in hospital.

I do not want to oversimplify the matter, however. Hospital discharge is a complex process which often involves patients, their families and clinicians having to make extremely challenging decisions which cannot be rushed. It must also be acknowledged that considerable pressure is being placed on hospitals by the scarcity of care services in the community.

Some 81% of delays were due to alternative care arrangements not being ready and the looming Brexit catastrophe makes it likely that this figure will only increase.

We are already experiencing a critical shortage of social care staff in Scotland and this will only be exacerbated by our departure from the European Union. It is immensely frustrating to consider that those from the EU who work so hard to take care of us may be told they are no longer welcome by a UK Government intent on delivering a No-Deal Brexit that Scotland did not vote for. If we cannot recruit from the EU, however, it is imperative that we retain those who are already working in the sector, while stepping up recruitment efforts. We must begin by re-evaluating how much we value those who take care of us.

Wages for care workers are scandalously low and the Scottish Government’s expectation that they be paid the living wage of £9 is woefully inadequate. Our society depends on the work undertaken by those in the care sector who are employed in frequently stressful and demanding jobs. Surely they deserve to be recognised for helping to keep us safe and comfortable while ensuring we retain our dignity. If these arguments are not persuasive enough, the estimated cost of delayed discharges is £122 million, so quality care is certainly a worthwhile investment.

Often it is about cultural, rather than structural, change. We need a more holistic system with closer collaboration between the NHS, third sector and local authorities so clinicians and discharge co-ordinators are aware of what community and care services are available. There are some resources, such as ALISS, a search tool which signposts people to relevant community support, but awareness of such schemes is low and are not accessible by those without access to a computer.

There also needs to be a shift towards prevention. Preventing unnecessary hospital admissions is ultimately the best way of reducing delayed discharge. In particular, those with chronic, long-term conditions, who may find themselves in an endless cycle of hospital admission and discharge, would often be better supported in primary and community care. Again, this depends on the availability of those services. We desperately need investment in primary and community care, so people are not being forced to turn to A&E as a last option.

Above all, the delayed discharge figures are a reminder that the pace of health and social care integration needs to increase urgently.

Integration should help to break down barriers between services, including the NHS, health and social care partnerships, social care providers as well as third sector services. This will lead undeniably to better collaboration and communication, to the benefit of all who use our health service. As the thousands of people who have experienced delayed discharge demonstrate, however, we are a long way off yet.