College welcomes new report on delayed discharges in Scotland

Commenting on the Auditor General for Scotland and the Accounts Commission report into delayed discharges in Scotland , Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh and a geriatrician with over 40 years’ experience in the NHS in Scotland said:

The College welcomes this important report and agrees with its conclusions, including the recommendation of a proper investigation into the effectiveness of delayed discharge policies in Scotland.

Delayed discharges are the clearest measurable indicator of the ineffective integration of our health and social care systems. Delayed discharges have existed in the NHS in Scotland for decades, pre-dating the current government’s tenure, but have become more visible in our acute hospitals as the capacity in “downstream” non-acute NHS facilities has been progressively reduced.  The ageing of our population is a societal triumph, but the failure to provide integrated health and social care for that population risks turning that triumph into a disaster.

Each delayed discharge is a person, with unique circumstances and needs, usually with a family who are affected by unwanted delays in hospital or by hurried discharge to inappropriate settings or home before the person is ready to be there. As the report highlights, the failure to resolve the problem now has significant knock-on effects for other patients requiring both acute and elective hospital care.

Reducing levels of delayed discharge- which reached a record high in 2024/25- must be a national strategic priority as they are continuing to adversely impact patient flow and quality of patient care. They are also an index of inequality of health care with older patients disproportionately affected.   

Ensuring that we have enough capacity within non-hospital settings such as residential care, as well as adequate resources to deliver homecare packages, is of critical importance. We urge the Scottish Government to work closely with local authorities and care sectors to address the significant challenges they continue to face around capacity and resourcing, including care staff shortages.

The report is right to call for measures to boost public awareness of the benefits of having a power of attorney or a guardianship order. Our College has argued for this consistently and we also urge the next Scottish Government to amend adults with incapacity procedures to allow patients to move from NHS facilities into social care facilities, in the same way that they can move between different NHS wards and hospitals.

Finally, people who need care, need humans to care for them. Technology may marginally reduce the need for human input in some settings, but will never replace person to person care, be that in a person’s home or residential setting. Our workforce strategy must keep that principle at its forefront.