What seems to be the problem?
One of the greatest challenges currently facing the NHS is the rising number of patients experiencing delayed discharge from hospital.
These are individuals who are medically fit to leave but are unable to do so.
The impact of such delays is particularly acute at a time when waiting lists are growing, A&E departments are overstretched, and winter flu places additional strain on services.
With fewer beds available, planned procedures are postponed, creating further knock-on effects across the system.
Extended hospital stays also carry significant risks, including hospital-acquired infections, blood clots, muscle deconditioning and pressure sores.
While most patients are ultimately discharged home, many require formal support.
This often depends on resources from the social care sector, a sector already under pressure from rising demand, staff shortages and chronic underinvestment.
The NHS frequently cites a lack of social care capacity as the primary cause of delayed discharge.
However, the reality is more complex. The process is fragmented and disjointed, hampered by insufficient resources, poor communication, opaque funding channels and disconnected systems.
What can be done?
To identify potential solutions, we must examine how responsibility is structured, how funding flows (or fails to), and the roles played by the many stakeholders within this tangled ecosystem.
Could the answer lie in creating a single body with sole responsibility for managing every aspect of the discharge process, backed by a single, unified funding stream covering all associated costs?
But first, what is the scale and nature of the problem?
Stand by your beds
Research from Nuffield Trust indicates that the total number of patients who were ready to leave hospital but were delayed 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.
When a patient is medically fit but unable to leave, the reasons typically fall into the following categories:
- Hospital process: Issues within the hospital’s control, such as waiting for medications, final tests or transport.
- Wellbeing concerns: Safety concerns raised by patients or families, or delays in assessing mental capacity.
- Care transfer hub process: Delays in identifying the appropriate discharge destination or securing funding.
- Interface process: Difficulties coordinating care with external services, such as home care or social care providers.
- Capacity constraints: A shortage of community beds, long-term care placements, or staff to deliver home-based support.
A May 2025 blog from The King's Fund notes that capacity is the most common cause of delayed discharge, and that the majority of these delays cannot be attributed to social care alone.
Who’s in (dis)charge?
At the centre of the NHS–social care interface are Integrated Care Systems (ICSs).
Established under the Health and Care Act 2022, ICSs bring together NHS organisations, local authorities and other partners.
Within each system, Integrated Care Boards (ICBs) are the statutory NHS bodies responsible for managing budgets and commissioning services.
In theory, the ICB holds overall responsibility for patient discharge.
It acts as the strategic lead, working with local authorities to arrange community support, such as care packages, to enable safe and timely discharge.
In practice, however, the system is not functioning effectively. Part of the difficulty lies in funding pressures, or, more accurately, in the inefficient deployment of existing funding.
A July 2025 blog by Dr Agnes Arnold-Forster on The Health Foundation reported that ICBs are facing cuts of 50% to their running costs.
Operationally, discharge decisions rest with multidisciplinary teams.
These include consultants or clinicians (who determine medical readiness), discharge coordinators or case managers (who manage logistics), nurses, social workers and occupational therapists.
A care coordinator often serves as the main point of contact, bridging health and social care services.
With so many actors involved, friction, communication breakdowns and financial inefficiencies are perhaps inevitable.
Show me the money
The discharge process is supported by several funding mechanisms:
- The Better Care Fund (BCF): A pooled budget combining mandatory contributions from ICBs and local authorities, used to support joint initiatives — particularly hospital discharge.
- The Hospital Discharge Fund: Previously a separate funding stream for short-term care packages, now consolidated within the BCF.
- Continuing Healthcare: For individuals with a primary health need, fully funded by ICBs, covering both healthcare and associated social care costs, including accommodation in care homes.
While these mechanisms are designed to enable collaboration, their multiplicity introduces administrative overhead and complexity — and complexity often translates into delay.
Faced with this reality, simplification appears to be the logical solution: a single accountable body, a single funding source and a clear mandate to deliver efficient, effective patient discharge.
Encouragingly, this could be achieved by strengthening and streamlining existing structures rather than building entirely new ones.
A new hope
Could a new service, founded on equal partnership between the NHS and the social care sector, backed by a direct, unified funding stream and mandated to implement best practice, provide the answer?
The central question remains: who would pay?
In a report by the BBC, Kerrie Allward, policy lead at the Association of Directors of Social Services, observed:
“Councils often lack the funds to invest in integrated services that would support more timely discharge.”
One potential solution would be the creation of a Health and Care Unified Discharge Programme.
Leveraging the existing ICB framework, this programme could be directly funded by the central government and given a clear mandate to implement a single, unified discharge pathway, with health and social care operating as equal partners.
While this may appear theoretical, some hospitals in North West England are already demonstrating what a unified approach can achieve.
In these cases, significant reductions in discharge delays and hospital readmissions have been reported, notably without direct ICB involvement.
Conclusions
Reforming large, complex systems is always challenging and frequently produces unintended consequences.
The NHS offers a textbook example: decades of incremental reforms have rarely delivered sustained structural improvement.
Delayed hospital discharge exposes deeper systemic issues in the relationship between health and social care.
Yet by examining these structural weaknesses more closely, it becomes clear that existing frameworks could be better aligned to deliver optimal outcomes.
The current system resembles a tangled web, the product of continuous policy adjustments, short-term thinking and piecemeal solutions.
However, the exceptional expertise within the NHS could be harnessed to engineer a simpler, leaner and more accountable model.
A unified discharge body would hold ultimate responsibility for ensuring that every patient leaves hospital in a timely manner, to an appropriate setting, with the necessary support in place.
This is not a quick fix. Structural reform takes time: turning a tanker is never easy.
But making the easier choices today risks compounding the problem tomorrow.