Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge

Appendix Three: What is delayed discharge?

A delayed discharge refers to the process when a person who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the ready for discharge date.

Put simply, when someone has been in hospital for a period of treatment or diagnosis, and have been determined as ready for discharge, if they are unable to leave hospital for a more appropriate setting then they will be considered to be delayed in their discharge.

The ready for discharge date is essentially a clinical decision, ideally taken in collaboration with the wider multi-disciplinary team, and is the point at which the person no longer requires treatment in a hospital setting. If that person is then still in hospital after midnight at the end of the ready for discharge date then the person is classed as a delayed discharge.

What we count

Adults, aged over 18, who have been delayed in their discharge from inpatient hospital care are counted in the statistics on delayed discharges. For the purposes of the delayed discharge census, hospital is defined as any inpatient bed provided in a substantial NHS facility. Information is collected by NHS Board of treatment, hospital and specialty (but not diagnosis), and also by the local authority of residence. The data is further broken down by age, sex and duration of delay. It is published in two sections – the first a snapshot of delays on the last Thursday of each month, which is shown by principle reason for delay on that day, and second by the overall bed days associated with the delays for that calendar month.

How we count

Data is collected from NHS Boards by Public Health Scotland and generally published on the second Tuesday of the month, approximately five weeks after the relevant monthly period.

Reasons for delay

The data is broken down by three broad headings – 'health and social care reasons', 'patient/carer/family related reasons' and 'code 9 cases'. Health and social care reasons are where the delays is in the hands of the NHS or local authority, whether undergoing an assessment or waiting for care arrangements, a care home place, funding or transport. Patient, carer or family related reasons are where the delay is mainly within the hands of the person themselves or their carer or family are the cause of the delay. This may include withholding of information, legal interventions or simply refusing to leave. It should be noted that people have the right to appeal the ready for discharge decision and that while that process in underway the person is not deemed as ready for discharge and therefore cannot be considered a delayed discharge. The third broad category is known as 'code 9'.

Code 9 – complex delays

All code 9 delays should have a "secondary reason code" that essentially provides the underlying reason for delay, despite its complexity.

These codes are:

24DX – People awaiting place availability in a specialist facility for high level younger age groups (<65) where no such facility exists in the partnership area and no interim option is appropriate (not to be used where a facility exists but has limited availability).

24EX - People awaiting place availability in a specialist facility for high level older age groups (65+) where no such facility exists in the partnership area and no interim option is appropriate (not to be used where a facility exists but has limited availability).

25X – People awaiting completion of complex care arrangements in order to live in their own home.

51X – People delayed due to the requirements of the Adults with Incapacity legislation (This code should be applied after it has been agreed that the person lacks capacity; the use of S13za of the Social Work (Scotland) Act 1968 to discharge the person has been ruled out; and an application for Guardianship or Intervention Order is to be progressed through the Courts. Once the process has been completed the person will revert to another reason code and the delay will be calculated from a new ready for discharge date.)

71X – People exercising their statutory right of choice where no interim placement is possible or reasonable. (This code should only be used where long travel distances or limited transport infrastructures restrict the ability of families and friends to visit and where the placement may isolate the individual from a vital family and social network. This code should only be applied where remaining in a hospital setting is a more appropriate outcome and is the only viable alternative to an interim move.)

Code 100

In addition to the delayed discharge codes there is a further set of people, not classed as delayed under the definitions, but who are going through a planned, phased commissioning process to develop alternatives to hospital in the community. Although not formally recorded as delayed discharge, data on these people is collected under "code 100".

Some concerns were raised in the group that there is inconsistency across Scotland as to how these codes are applied to people with learning disabilities. It is anticipated a national Register would address data inconsistencies.