The number of patients trapped in hospital despite being fit to leave is three times higher than official data shows, according to a study.

Nuffield Trust, a health thinktank said far more hospital beds were taken up by patients classed as “delayed transfers of care” than NHS England’s counting system detected.

NHS bosses said the findings bore out their own experience and the official figures hugely underestimated how many people had to stay in hospital because of problems elsewhere.

Nigel Edwards, Nuffield Trust’s chief executive, who undertook the research, said: “Our audits show that up to two-thirds of the patients stuck unnecessarily in hospital beds aren’t actually being counted in the official figures.

“That means that a typical 650-bed hospital may actually have only around 250 beds available for all its emergency patients, once you’ve taken out all the people who could go home if they had more support, and discounted maternity, paediatric and cancer beds.”

Delayed transfers – which some call bed-blocking – are running at their highest ever level, with 193,680 bed days lost because of it in November, according to the most recent official NHS figures.

Edwards cited his thinktank’s own research about bed occupancy trends at three small and medium-sized hospitals NHS hospitals and a separate study of 7,500 bed days in a large number of bigger hospitals.

In one small rural hospital, only 40 (14%) of the 277 patients examined were counted as delayed transfers of care (DToCs). However, 80 others (29%) were also fit to leave, and another 35 (13%) were not medically fit to be discharged but could have been safely looked after in a nursing home if places in them had been available.

Separate research by the Oak Group, a firm that reviews inpatient stays, found the same picture in the bigger hospitals it analysed. “These audits confirmed that significant numbers of patients could be cared for elsewhere; for typically 50%-60% of the acute bed days examined,” Edwards said.

He said 19% could have gone home without receiving any support afterwards, 28% needed nursing or social care support in order to get out of hospital, and 12% needed long-term supported live-in nursing or residential care.

“This failure to record the true situation is significantly increasing the pressure hospitals are facing. Speeding up the discharge of patients who would be better cared for elsewhere needs to be the top priority for the NHS and social services departments,” Edwards added.

Chris Hopson, the chief executive of NHS Providers, which represents NHS trusts, said: “Our hospital members tell us that because the official definition of delayed transfers is so specific, the actual number of patients medically fit to discharge, or who could be cared for in other settings, is much greater than the definition implies. So in that sense the problem of blocked hospital capacity is significantly greater than the DToC figures by themselves suggest.”

Separately, Whitehall’s spending watchdog has concluded that a £5.3bn reserve designed to relieve strain on overcrowded hospitals by integrating health and social care is failing to save money or stem the rise in admissions.



The Better Care Fund has not achieved the main targets set for it when it was established two years ago by the health secretary Jeremy Hunt, according to a report by the National Audit Office.

Health officials hoped to use the fund to reduce emergency admissions by 106,000, but the report discloses that admissions instead rose by 87,000. The fund was supposed to be used to make savings of £511m, but instead spent an additional £311m, the report says.

Officials had aimed to reduce the days lost when patients are ready to leave but cannot do so by 293,000, but instead that figure rose by 185,000, costing £146m more than planned, it adds.

Norman Lamb, the Liberal Democrats’ health spokesman, who helped draw up plans for the fund when a coalition minister, said the report showed the NHS was hurtling towards a “catastrophe” without a bigger financial injection.

“This does not undermine the case for joining up health and social care and ending the irrational divide which too often lets patients down. But it is a clear warning that with demand rising so rapidly, more funding is needed,” he said. “It would be unforgivable for the government not to act in light of these warnings.”

Meg Hillier, the chair of the public accounts committee, which scrutinises public spending for parliament, said the “deep flaws” in the fund were first highlighted two years ago but the warnings had not been heeded by ministers.

Under the Better Care Fund, councils receive money, mainly from the NHS budget, in return for introducing schemes to reduce demand for hospital care.

Auditors found that the Department of Health and NHS England were both over-optimistic about what the fund could achieve.

The NAO did notice some benefits from the fund, such as 90% of local areas agreeing or strongly agreeing that delivery of their plan had improved co-operation between different bodies.

A Department of Health spokesperson said: “The Better Care Fund is just one element of this government’s programme to integrate health and social care for the first time – and as the report recognises, it has already incentivised local areas to work together better. We will build on this for the future in making care even more joined up.”



An NHS England spokesperson said the NAO report was a “statement of the obvious” because the NHS never believed or claimed that cutting hospital budgets to fund social care would by itself save money.

“The obvious lesson for next phase of care integration is that joining up local NHS and council services may be worthwhile, but is not by itself a silver bullet solution to wider pressures on health and social care,” she said.

• This article was amended on 8 February 2017 to correct the percentages of patients in one small rural hospital who were counted as delayed transfers of care and those who were in fact medically fit for discharge.