Half a Million Bed Days Spent Keeping People Living with Dementia in Hospital Unnecessarily
Alzheimer’s Society has published – for the first time – data revealing the true extent of delays to discharge from hospital for people living with dementia, and the knock-on effect for NHS winter pressures. Figures show that around a quarter (24%) of people aged 65 and over who are fit to be discharged but are kept in hospital for a week longer than necessary are believed to have dementia – nearly 29,000 people in one year.
The NHS England data, analysed by HSJ Information and Alzheimer’s Society, also shows the impact of dementia on delayed discharge gets worse the longer people stay in hospital. The proportion of people believed to have dementia rises to almost a third (31%) for patients kept in for at least 21 days longer than they should be.
Delayed discharge from hospital happens when someone is deemed medically fit for discharge but is unable to return home. While the insights released today do not include the reasons for delays, it is well known that the causes are often poor planning and availability of dementia-appropriate follow-on support in health and social care services.
Delayed discharge reduces the numbers of beds available, creating bottlenecks that affect other parts of the NHS and exacerbate current winter pressures.
Staying in hospital unnecessarily increases a person’s risk of complications. Delayed discharge can be especially damaging for people living with dementia, who are more likely to struggle with the unfamiliar and often distressing hospital ward environment. Risks include infections, falls, worsening cognitive function, poor mental health, malnutrition and dehydration.
The figures also reveal wide-spread variation at a local level, with some integrated care boards (ICBs) faring much worse than others. For example, Suffolk and North East Essex ICB reports that one in five people (19%) aged over 65 kept in hospital for 21 days longer than necessary were believed to have dementia. This proportion more than doubles at North Central London ICB, where 44% of over 65s kept in longer than 21 days were believed to have dementia.
Michelle Dyson CB, CEO of Alzheimer’s Society said: “Every year, the NHS faces extreme winter pressures and we see time and time again the struggle to cope with the numbers of people needing urgent care. It is clear from these figures that dementia is a key part of the puzzle. People living with dementia are being left stranded in hospital, which is neither good for them nor the NHS.
“Tackling dementia care and support would make a huge difference to the NHS’s ability to cope at this time of year. Early diagnosis and access to appropriate services can help to prevent hospital admissions in the first place, while better care and support would also mean those in hospital could leave when they are well enough.
“The Government has a once-in-a-decade opportunity to fix this, as it prepares its new blueprint for dementia health and social care, the Modern Service Framework. Dementia is the UK’s biggest killer and the greatest challenge facing health and social care services. The new plan must rise to the magnitude of the challenge, improving care to keep people healthier for longer and ultimately reduce the devastation caused by dementia.”
Martin Farran, 64, is a semi-retired director of social care services who lives in West Yorkshire. His mum, Sarah, is 88 and lives in a care home in Lancashire. She was diagnosed with Alzheimer’s disease in 2018.
Sarah has had multiple hospital admissions over the years as a result of falls and urinary tract infections (UTIs). Once in hospital, she has routinely been kept in longer than necessary, despite a care package being in place for her to return to her accommodation.
In 2023, Sarah spent a month on a surgical ward. She had not had – and nor did she need – surgery. Martin was away at the time and says his sisters were fobbed off when they asked questions about why she was there and when she would be discharged. Martin eventually insisted on taking her home, but even then had to persuade staff that he could come back to the hospital later to collect a prescription, instead of keeping her in several more hours to wait for it.
Martin says: “I know from my professional career how big a challenge dementia is for health and social care but it wasn’t until mum became unwell that I understood the gravity of what it is to live with it. I am generally very positive about the NHS – and the staff who have looked after mum at various times have been very kind – but the system just isn’t set up to deal with dementia.
“When she was in sheltered accommodation, nearly every fall or UTI resulted in a hospital visit, which was completely unnecessary. Those hospital stays really affected mum. The staff don’t usually have the time or the training to talk to patients, get to know them and help them understand what’s happening. As a result, she was confused and very isolated, which wasn’t good for her mental health. Her physical health has taken a hit too – if you don’t support someone with dementia to stay active, their mobility can decline very quickly.
“Now she is in a care home, she’s getting much better support. They are better equipped to manage dementia, which prevents the need for disruptive hospital visits. With my mum, for example, they are good at helping her stay hydrated, which in turn reduces the risk of UTIs and falls. She’s finally getting the dementia-specific care she needs and the impact is really clear – her physical health is good, she sleeps really well and she has people around her for company, which makes a huge difference to her mental wellbeing.”
Professor Martin Green OBE, Chief Executive of Care England, said: “The system is not working for people with dementia, and I am very grateful for the important work Alzheimer’s Society is doing to bring this issue to light.
“Social care should be seen as a critical partner to the NHS, receiving the funding needed to deliver the best outcomes for people living with dementia. This is particularly important in the context of winter pressures; the capacity in social care needs to be utilised in order to ease pressure on the NHS and deliver for patients.”
Adam Gordon, Professor of the Care of Older People at the Academic Centre for Healthy Ageing, Queen Mary University of London, and Chair of Alzheimer’s Society’s Clinical Advisory Group, said:
“These figures paint a stark picture of delayed discharge from hospital for people living with dementia. As a practicing clinician, I see the real trauma that these delays cause to people living with dementia and their families. The knock-on effect caused by unnecessary additional pressure on the NHS during its busiest winter months makes it difficult for us to give our patients the care they deserve.
“That’s why we need to address the root causes of avoidable hospital admissions, by improving early and accurate diagnosis, and the quality of care and support people living with dementia receive. We also need more timely and expert care for people living with dementia when they need to come into hospital, to ensure they can return home promptly and in the best possible health. The Modern Service Framework for Frailty and Dementia offers a vital opportunity to fix these foundations, through a clear focus on improving dementia care pathways. We must make the most of this opportunity.”
Rates of delayed discharge from hospital have risen steadily since the pandemic but as yet data on dementia specifically has not been publicly available. The data comes from NHS England and has been analysed by HSJ Information and Alzheimer’s Society. It includes use of private beds by the NHS. In total, keeping people living with dementia in hospital unnecessarily accounts for 584,080 bed days, which the charity estimates cost the NHS £328m in 2024/25.
