Can the seemingly intractable problem of delayed hospital patient discharge be solved by the creation of a single responsible body?

One of the biggest challenges facing the NHS is the growing number of patients experiencing delayed discharge from hospital, meaning they are medically fit to leave but unable to do so.

The impact of delays is especially acute when waiting lists are rising, A&E departments are overstretched and the winter flu season is under way.
On top of that, because there are fewer available beds, planned procedures are also affected.

Finally, there are many risks associated with longer stays: infections; blood clots; muscle weakening and pressure sores, to name a few.

While most patients will be discharged to their home, many require more formal support, often involving resources from the social care sector.

However, within the discharge system there is friction, with the NHS often citing lack of social care capacity as the primary reason for delayed discharge, but the problems run much deeper. It is a complex, disjointed process, exacerbated by a lack of resources, poor communication, confusing financial channels and fragmented systems.

We know there are enormous pressures on the NHS, but pressures on social care services are well documented too. Growing demand, staff shortages and underinvestment have severely affected the capacity available to deliver care.
On the plus side, there is no shortage of data, analysis and proposed fixes. Everyone knows the extent of the problem, even if only through the lens of a febrile media, so why does it persist?

What can be done that has not already been tried?
Here, we break down the various components of the system to see where responsibility lies, how funding works (or does not) and examine the roles of the many players in this tangled ecosystem.

Could the answer be simplification? Creating a single body with sole responsibility for handling every aspect of the discharge process, and with a single source of funding that covers all cost areas, could bring with it the accountability that is today tellingly missing.

But first, what is the scale and nature of the problem?

According to a piece on the Nuffield Trust website from September last year, ‘The total number of patients who were ready to leave hospital but were delayed has increased by 43% from an average of 8,545 patients per day in June 2021 to 9,933 patients per day in June 2025. At its peak, in January 2024, there were 14,096 patients delayed in hospital.’

The Nuffield piece goes on to note the seasonal impact: ‘Every winter sees an increase in A&E admissions and a reduction of staff due to sickness absence that can hinder effective discharge processes within hospitals.’

When a patient is medically fit but cannot leave, the reasons are classified as:

• Hospital process: issues within the hospital’s control, such as awaiting medications, final tests or transport
• Well-being concerns: concerns from the patient or family about safety, or delays in assessing mental capacity
• Care transfer hub process: delays in identifying the appropriate destination or funding
• Interface process: delays in coordinating care with external services such as home care or social care
• Capacity: shortages of available community or long-term care beds, or lack of staff to provide home-based support.

There are multiple parties involved at different stages of the patient discharge process, but the NHS and social care sectors are the key players.

The NHS is vast and complex, and its multiple interactions with the social care sector are predictably Byzantine. They are two distinct systems, funded differently and often facing different demands.

Focusing on the relationship between the two bodies, and digging deeper into the systems that most directly affect patient discharge, we first find Integrated Care Systems.

ICSs and Integrated Care Boards are part of the NHS structure established by the Health and Care Act 2022. ICSs are the overall partnership, while ICBs are the statutory NHS bodies responsible for managing the budget and commissioning services.

For clarity, the body with overall responsibility for patient discharge is the ICB, of which there are currently 42 within the NHS in England.

ICBs work with local authorities to arrange community support, such as care packages, to get patients home safely and quickly.

In essence, the ICB acts as the strategic lead, ensuring the whole system works together to discharge patients safely and effectively, and preventing delays.

But it is not working, or at least not well enough, and that is partly due to a lack of proper funding, or at least inefficient use of existing funding.

According to a July 2025 blog by Dr Agnes Arnold Forster on The Health Foundation website, ‘ICBs are facing cuts of 50% to their running costs.’

On a day-to-day basis, responsibility for discharging lies with a multidisciplinary team, including the consultant or clinician, the discharge coordinator or case manager, nurses, social workers and occupational therapists, and involving the patient and his or her family.

A care coordinator often acts as the main contact, bringing together health and social care professionals.

With so many bodies involved it is not surprising to find friction, communication problems and financial challenges.

With such a plethora of bodies involved in the discharge process, how is funding coordinated? Here are the key mechanisms.

The Better Care Fund is the main pooled fund, combining mandatory contributions from ICBs and local authorities. It is used for joint health and social care initiatives, with a significant focus on hospital discharge.

The Hospital Discharge Fund manages funds for ICBs and local authorities to pay for short-term care packages. This funding is now consolidated within the BCF.

Continuing Healthcare is for individuals with a primary health need. ICBs fund the entire health and social care costs, including personal care and accommodation in a care home, and they fund a standard weekly rate for the nursing care component for eligible residents in nursing homes, separate from personal care costs.

So, there are multiple sources of funds, coming from various places and channelled through various networks, but the management of all this adds considerable overhead and introduces complexity, which in turn creates delays.

In the face of such complexity, the obvious response is to simplify. A single body, a single source of funding and a clear mandate for delivering optimally efficient patient discharge.

The good news is that this can be achieved within the current system by improving existing mechanisms.

Is it possible that a new service, based on an equal partnership between the NHS and the social care sector, with a direct single source of funding and a mandate to implement best practice for patient discharge, could be the answer?

The key issue is who pays for a discharge service that requires the cooperation of both health and care sector bodies.

In a report by the BBC, Kerrie Allward, who acts as a policy lead for the Association of Directors of Social Services, said: “Councils often lack the funds to invest in integrated services that would support more timely discharge.”

In a report produced for the Commons Library in 2019, before the pandemic made everything worse, it was noted that, ‘An increasing number of people are living longer with multiple long-term health conditions, and require support from a wide range of services at home, in the community and in hospitals.’

Meanwhile, in a report from July 2023, Age UK noted, ‘2.6 million people in England aged over 50 are unable to get care.’

We can fix this. The creation of a new body, a single ‘health and care unified discharge programme’, could take advantage of the ICBs to define and implement this new service, which would be funded directly by government.

This new service envisages the health and care sectors being equal partners in delivering a single, unified discharge programme, no longer a piecemeal, fractured association of individual services stitched together.

This unified service would bring the health and care sectors together, with a clear mandate to implement a programme that benefits the NHS, the social care sector and, most importantly, patients.

You could be forgiven for thinking this all sounds very nice in theory, but some hospitals in north west England are already demonstrating what can be achieved with such a unified approach. Patient discharge delays and hospital readmissions have been cut significantly.

In this case, the local ICB was not directly involved.

Making changes to a complex system is a major challenge, very often leading to unintended consequences.

The NHS is a textbook case. Governments seem unable to resist tinkering, and the results of this over the past 50 years have not been encouraging.

The problems with hospital patient discharge serve to expose and highlight structural, systemic issues within the service and the relationship it has with the social care sector.

Yet, simply by shining a light on these issues it is possible to see how existing structures, systems and processes could be used to deliver better, more efficient patient discharge.

It looks like a tangled mess – one that has emerged through continuous tinkering and interference, short-term thinking and patched up solutions – but the exceptional talents within the NHS can be harnessed to engineer a new way of working that is simpler, stripped back and lean.

The new body would be ultimately responsible for ensuring every patient is discharged in a timely manner, to an appropriate destination, with all necessary support measures in place.

This is necessarily a longer term solution; it takes time to turn a tanker. But as everyone knows, making the easy choice now only leads to greater pain later, and vice versa. 

Norman Niven is CEO at The Medication Support Company