Concerns that support for patients from social care or nursing in the community has been cut back, resulting in 'bed-blocking'

One in four patients are occupying hospital beds when they could be sent home to continue their recovery, according to the head of the NHS Confederation.

Mike Farrar, chief executive of the confederation, which represents NHS management, said there was now "a potential loss of confidence in the NHS".

In a shot across the government's bows, Farrar said key challenges for the service were the forthcoming cash squeeze; concerns about the quality of care, especially for older people; "minimising distraction" during the upheaval of NHS reforms; and a lack of political will to fill the black hole of social care funding.

The veteran NHS executive said that making £20bn in efficiency savings while embarking on the biggest shakeup of the NHS in 60 years was never going to be easy but argued that politicians had "failed to support the NHS even when the case for change has been clear".

With the NHS bill still stuck in parliament almost a year after it arrived, he said it was time for MPs and ministers to be "honest about the issues, bold about the solutions and decisive in taking action".

One big issue is elderly care. Farrar said NHS leaders believed that at least 25% of patients in hospital beds could be better looked after in the community or could look after themselves at home rather than in the "outdated hospital model of care".

With money short, there has been increasing concern that support for vulnerable patients from social care, paid for by councils, or from NHS-funded nursing in the community, has been cut back. The result is bed-blocking as patients face increasing delays in being discharged from hospital.

New data from the Department of Health shows delays in discharging patients from hospitals are increasingly being blamed on the NHS rather than local authorities. This is despite the fact that councils' social services budgets have been cut by 7% on average whereas the health service is looking for "efficiencies" of just 4%.

The number of days of delay for acute patients recorded as "attributable" to the NHS rose to 47,000 in September. This is 14% higher than in April. There were fewer than 14,000 delays due to social care, a rise of only 4%. Farrar said: "Care would be better for frail patients who would have fewer crises, shorter hospital stays when they need them, and more time in the comfort and safety of their homes.

"Hospitals play a vital role, but we do rely on them for some services that could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self-care. There is a value for money argument for doing this, but it not just about money and the public need to be told that."

Labour seized on the figures. Liz Kendall, the shadow social care minister, said that more than £250m had been spent on "delayed discharges" since August 2010 – amounting to £550,000 a day.

Kendall said the NHS Confederation was "right to say this will require real leadership, from the NHS and politicians – leadership this Conservative-led government has completely failed to provide".

She added: "When the NHS should have been focused on meeting the biggest financial challenge of its life and on improving patient care, the government has instead wasted 18 months forcing through a costly and risky reorganisation. Frail elderly patients and those with long-term conditions need joined-up NHS and social care services that focus on prevention and early intervention."

The health minister Simon Burns said: "Every health system in the developed world faces the challenges of rising demand, an ageing population and increasing costs of treatment, and these challenges won't be met by the NHS doing more of the same. That is why our plans give doctors, nurses and frontline professionals the freedom to make the best decisions for patients."