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This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.

This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.

Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.

This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

Delayed hospital discharge has long been of policy interest in the UK. This paper presents findings from a comparative study of policy and approaches to implementation of reimbursement, in England, and Joint Action Planning, in Scotland, designed to tackle the problem of delayed hospital discharge.

This paper considers the development of policies to implement the Community Care (Delayed Discharges etc) Act 2003 in one locality. It argues that the legislation has stimulated new thinking about the management of the problem of delayed discharge, although many issues remain to be resolved in its implementation.

This paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England.

Panel econometric models on data from local authorities with adult social care responsibilities in England between 2013–2014 and 2018–2019.

After controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year.

Given the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds.

This is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England.

The purpose of this paper is to demonstrate that nurse led discharge (NLD) could improve the efficiency of simple discharges from a short stay surgical ward without compromising patient safety.

A protocol for NLD was designed and implemented. Introduction of the protocol was audited and re-audited prospectively.

Introduction of the nurse led discharge protocol significantly reduced the rate of delayed discharge (p>0.001). The protocol successfully identified all patients for whom a NLD would be inappropriate and no patients discharged by the nursing team were re-admitted.

No formal measure of staff and patient satisfaction with the new protocol was performed.

The nursing team are now able to more effectively manage patient flow through the short stay surgical ward. Mismatch between demand for beds and capacity has reduced.

Patient experience has been improved by the release of time to care for our nurses and the elimination of unnecessary delay in discharge.

Formal protocol driven NLD can be a safe way of improving efficiency in patient flow. This pattern of discharge could be applied in many hospital systems.

Using the findings from a CSCI study undertaken in the first months after the implementation of the Community Care (Delayed Discharges) Act 2003, this article outlines key issues for the immediate future. It is the third in a sequence of articles in the Journal of Integrated Care on this priority policy issue, and the first to report on implementation.

The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.

A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.

There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.

The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.

This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism.

Purpose – Aims to describe a project carried out within Hampshire Social Services investigating potential care pathways for older people after discharge from hospital and to show the potential of the simulation methodology in such situations. Design/methodology/approach – A discrete‐event simulation was used to determine the system capacities and to estimate the likely associated reimbursement costs. Findings – A prototype simulation model was developed showing the potential value of this approach. Research limitations/implications – Restrictions in data access shifted the focus from quantitative service mapping to a more descriptive approach. Practical implications – Currently, many older patients experience delayed discharge from acute beds because of capacity limitations in Social Services’ traditional post‐acute care services. At the same time, new regulations require Local Authorities to reimburse NHS Acute Trusts if hospital discharge is delayed solely due to inadequate provision of social care assessments and services. In order to overcome the so‐called “bed‐blocking” problem, a new range of services termed “Intermediate Care” has been introduced to offer alternative options for older patients. These services are examined in terms of capacity and appropriateness. Originality/value – This paper fulfils an identified need to record and evaluate the new post‐acute packages introduced by the Social Services and NHS and proposes simulation as one of the most suitable methodologies for such objectives.

Intermediate care has featured strongly in evolving strategy for support provision for older people in England. In Scotland the concept appears to have been rejected in favour of an emphasis on integrated care. This apparent divergence is explored in the broader context of policy variation post‐devolution and against the aspirations for a whole‐system approach.

The purpose of this paper is to provide a commentary from a Scottish perspective on some of the issues raised in the paper “Variation in rates of inpatient admission and lengths of stay experienced by adults with learning disabilities in England”.

The policy context in relation to people with learning disabilities in Scotland is reviewed, alongside an update about a current Scottish Government project focussed on understanding and addressing the issue of people with learning disabilities whose discharge from hospital is delayed.

As regards to people with learning disabilities who are inpatients in hospitals in Scotland, there are similar themes in common with those in the paper by Elaine James and colleagues; however Scottish policy has developed differently from that in England in this area.

This commentary adds to the discussion by contributing a Scottish perspective on issues and outlines work being done to address the need for people with learning disabilities and complex needs in Scotland to live within their local communities.