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Analysis

Delayed discharges from hospital: comparing performance this year and last

Published 14 December 2025
Time to read clock icon About 9 mins
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Key points

  • Delayed discharges from hospital are bad for patients, increasing the risk of infection, mobility loss and worse mental health. They also reduce the availability of hospital beds, contributing to delays in ambulance handovers and admitting patients from A&E.
  • Between July to September 2024 and July to September 2025, the percentage of bed days used for patients whose discharge from hospital was delayed rose from 10.1% to 11.0% – an increase of 9%, or around 19,000 bed days.
  • This increase was primarily driven by an 8% year-on-year rise in the number of delayed discharges, equivalent to around 3,800 discharges a month. The average length of delay and total number of discharges saw only minor changes.
  • During winter 2024–25, the percentage of beds occupied by patients ready for discharge peaked at 14%, contributing to severe pressures on hospitals that led to record numbers of patients waiting in A&E for 12 hours or longer. Our analysis indicates that delayed discharges are likely to increase pressures in A&E departments compared with last winter.
  • There is substantial variation in performance between individual trusts. Between July to September 2024 and July to September 2025, 63% of trusts reported an increase in the proportion of bed days used by patients whose discharge from hospital was delayed while 37% of trusts reported an improvement in performance.
  • We analysed the impact of trends in bed occupancy and changes in staffing levels at the seven trusts with the most improved performance over this period.
  • All seven trusts saw increases in nursing levels, suggesting a possible link between nursing capacity and discharge performance. However, trends in the number of doctors and bed occupancy proved inconclusive, indicating wider factors could play a bigger role, such as how discharge care is organised and capacity in social and intermediate care.
  • Reducing delayed discharges will be vital to meet ambitious targets for reducing delays in A&E, set out in the government’s Urgent and Emergency Care Plan and the recently published Medium Term Planning Framework for the NHS.
  • In the long term, reducing delayed discharges will require increasing capacity in social and intermediate care, NHS capital investment in areas such as bed capacity, and implementing best practices for patient discharge across all trusts.
 

Background

Delayed discharges remain a critical issue in health and care services. In September 2025, around 11% of hospital bed days in England were occupied by patients medically fit for discharge – slightly worse than the 10% seen in September last year. These delays increase risks to patients and strain system efficiency, reducing ward capacity, lengthening A&E waits and prolonging ambulance handovers.

This is not a new issue. Before the COVID-19 pandemic, the number of beds occupied by patients ready for discharge averaged around 4,000 to 5,000 per day. We cannot directly compare current levels to those pre-COVID because the way data are collected has changed, but the number of patients fit for discharge remaining in hospital rose extremely fast from 2021. As of 30 September 2025, a substantial 12,459 beds were occupied by patients fit for discharge, costing the NHS an estimated £220m that month alone and preventing beds from being used by other patients. 

The causes of delayed discharge are complex, involving internal hospital processes, capacity constraints in social and intermediate care, and coordination across services. Although the NHS regularly publishes data on the number of patients whose discharge from hospital was delayed (referred to as ‘patients with delayed discharges’ in this analysis), as well as the reasons for delays, these data are limited, complicating efforts to fully understand and address the issue.

The impacts of delayed discharges are an important issue for national policy. A metric on length of delays is included in the new hospital league tables that are intended to increase the scrutiny of NHS trust performance, while the Urgent and Emergency Care Plan 2025/26 acknowledges the wider impact of delayed hospital discharges on performance in urgent and emergency services and system-wide pressures. There are no specific targets, however, on reducing delayed discharges in the new planning framework. Making and sustaining reductions in the number and length of delays will be critical for meeting the ambitious new recovery targets for A&E performance set by the NHS Medium Term Planning Framework. 

About this analysis 

The analysis uses publicly available data to compare delayed discharge performance last summer (July to September 2024) with this summer (July to September 2025). We outline national trends in discharge performance in England, and identify trusts that have achieved the greatest reductions in hospital bed days used for patients with delayed discharges. Finally, we analyse two main drivers: hospital bed occupancy and staffing numbers. Notably, we were unable to examine changes in several important likely drivers: the organisation of discharge care (such as discharge hubs and improved use of digital tools) and capacity in social care and intermediate care.

Box 1: Data and approach

This analysis uses NHS England’s monthly ‘discharge ready date’ data. These data have been published since September 2023. Additional information has been included in the datasets since April 2024 and therefore this analysis extracted monthly data from this point onwards. The dataset includes the number of patients who were discharged on the date they were first considered to be medically fit for discharge (their ‘discharge ready date’) and the number discharged at least 1 day after their discharge ready date.

The analysis also uses the urgent and emergency care daily situation reports for the bed occupancy rate among adult general and acute beds, including both core and escalation beds. These data were available for each month, with the total number of available and occupied beds averaged over that month.

Staffing information was extracted from monthly NHS workforce statistics. The analysis uses hospital and community health service doctors’ values for our clinician counts, and nurses and health visitors values for our nursing counts. The latest available data we have for staffing is the period May to July.

We divide the number of bed days used for patients medically fit for discharge by the number of total acute adult beds, to determine the percentage of bed days occupied by patients fit for discharge both nationally and for each trust. We compare results for an average across July to September 2024 against the same period for 2025. Using a 3-month average for both periods allows us to identify sustained reductions, rather than one-off monthly variations in the data. The percentage change in bed days occupied by patients fit for discharge is then calculated for the 107 acute trusts that report data consistently, out of a total of 120 acute trusts (excluding specialist, children’s and women’s hospitals).

We identified trusts with a reduction greater than 2.5 percentage points in the percentage of hospital bed days used for patients with delayed discharges, as the most improved trusts in England. We excluded trusts that had not sustained consistent improvements over the whole study period, therefore improvements in delayed discharge performance in these trusts can be considered the result of consistent changes over time. For these seven trusts, we analysed bed occupancy and staffing levels to identify potential reasons for sustained improvements.

Since the monthly discharge ready date publication is relatively new, there are several potential limitations of our analysis. With 107 trusts successfully submitting data across 15 months, we do not have a fully accurate understanding of the national position. There are two potential limitations: these trusts may not be representative of all trusts nationwide; and other trusts not included in this study may have achieved a higher rate of improvement. We aimed to focus on sustained improvement – comparing summer 2024 data to summer 2025 – to avoid any issues with irregularities in month-on-month comparisons. 

While we have focused on the most improved trusts in terms of the percentage of bed days occupied by patients fit for discharge, these statistics do not account for the potential impact on patient care or wellbeing outcomes. It is unclear whether patients have been discharged prematurely, which could potentially lead to increased re-admission rates. Further analysis is needed to assess this.

 

Changes in discharge delays over the past 12 months

National-level changes

Delayed discharge performance in England worsened between July to September 2024 and July to September 2025. The percentage of bed days used for patients with delayed discharges rose from 10.1% to 11.0% during this period – a 9% increase, or around 19,000 bed days (Figure 1). This was primarily driven by an 8% rise in the percentage of discharges that were delayed, equivalent to around 3,800 discharges a month (from 13% to 14%). The number of patients discharged from hospital remained stable at around 337,000 a month on average, while the average length of delay decreased slightly from 6.2 to 6.1 days. 

Figure 1

Despite a reduction in discharge delays being identified as a key priority in the Urgent and Emergency Care Plan, our analysis indicates the NHS is heading into this winter in an even poorer position than last. 

Delayed discharges have knock-on effects throughout the urgent and emergency care pathway. They are particularly disruptive in a health system with very high bed occupancy like the NHS, with few spare beds to admit patients from A&E departments. NHS trusts have seen a rapid rise in 12-hour trolley waits (after the decision to admit to a hospital bed) since the COVID-19 pandemic. High bed occupancy on wards contributes to delays further upstream in A&E and ambulance handovers, although processes around the organisation of care also contribute to these delays. 

With delayed discharge performance looking worse heading into this winter compared with last, the NHS faces a huge challenge in delivering the stretching commitments of the Urgent and Emergency Care Plan and Medium Term Planning Framework.

Trust-level changes

National-level figures on discharge delays mask substantial variation between individual trusts. Between July to September 2024 and July to September 2025, 63% of trusts experienced a deterioration in performance, with a higher proportion of bed days occupied by patients with delayed discharges. 37% of trusts reported improved performance. 

Across England, 11 trusts reported a reduction of more than 2.5 percentage points in bed days occupied by patients with delayed discharges. In contrast, the median across the 107 trusts for this time period was a 0.5 percentage point increase. 

To identify potential reasons behind these improvements, we conducted an exploratory analysis on this subset of trusts. Four of the trusts were excluded due to data concerns and inconsistent long-term performance. From here onwards, we focus on the seven most improved trusts, shown in Figure 2. 

Figure 2

Six of the seven trusts had higher than average discharge delays in July to September 2024. But these trusts substantially improved their position over the 12-month period. Given these improvements, assessing the possible drivers among these trusts can offer valuable insights for system leaders, national policymakers and other trusts more widely. 

 

Performance among the seven most improved trusts

Here, we review trends in bed occupancy rates and staffing levels among the seven trusts, using publicly available data. 

Bed occupancy

Reducing bed occupancy – the percentage of beds occupied by all patients, including those fit for discharge – creates a more flexible system, enabling smoother patient flow and potentially improving discharge performance. When hospitals operate at or near full capacity, limited space can lead to bottlenecks in the system, increasing the likelihood of discharge delays. The majority of trusts in England are still exceeding the 92% bed occupancy rate considered to be NHS England’s maximum limit for hospitals to work safely and effectively.

Among the seven trusts with the greatest improvements in delayed discharges, we observed variation in bed occupancy trends. Two trusts saw large increases in their bed occupancy rate (Liverpool and South Warwickshire), one trust saw a large reduction (George Eliot), but the others saw little change (Figure 3). Across the seven trusts, the average bed occupancy rate was in line with the national median and both remained stable over the past 12 months. Due to the variation across the seven trusts, this suggests reducing bed occupancy was not a leading driver of improvements in delayed discharges; and conversely, that improving bed occupancy did not lead to a systematic reduction in bed occupancy in these trusts.

Figure 3

Staffing

Staffing increases may also improve delayed discharge performance by making more staff available to ensure timely patient assessments, treatment and discharge planning. This may help trusts to coordinate care and address discharge barriers more efficiently, contributing to patients leaving hospital more quickly after the decision to discharge is made.

Almost all the most improved trusts experienced staffing increases in this time period. The number of full-time equivalent (FTE) nurses increased in all of the most improved trusts, with an average increase of 2.7% (compared with no increase at the national level). The seven most improved trusts have increased the number of FTE doctors in line with the national median, although two saw notably large gains (Figure 4). All seven trusts saw an increase in nursing capacity, contrary to the national median, which saw a slight reduction. This could suggest that nursing capacity improved discharge performance. However, further exploration is required to assess the impact of an increase in doctors, nurses and the interaction between them.

Figure 4

 

Improving discharge delays across NHS trusts

Our analysis highlights delayed discharges are a persistent challenge for the NHS. At the national level, the percentage of all-hospital bed days used for patients with delayed discharges increased by 9% between July to September 24 and July to September 25. This suggests we are heading into winter 2025–26 in a more precarious position than the last. Having more than 11% of bed days occupied by patients who no longer need to be in hospital contributes to high bed occupancy, difficulty in admitting patients from A&E and delays throughout the urgent and emergency care pathway. 

Over this period, seven trusts achieved substantial improvements – a decrease of more than 2.5% in bed days used for delayed discharge. Our analysis offers some insight into the drivers of these improvements. All trusts experienced increases in the number of nurses, while there was no change at the national level: this indicates that increased nursing capacity may have helped improve discharge performance in these trusts. However, improvements in delayed discharge do not appear to be associated with a reduction in bed occupancy, and further work would be needed to understand the impact of an increase in doctors.

Lack of consistent trends point to the importance of other drivers where there are little or no national data. Most likely, improvements in delayed discharge performance are linked to changes in how care is organised. This could include the establishment of discharge hubs; better coordination between hospital and community teams; early discharge planning; and improved use of digital tools. In addition to improved processes, the NHS needs appropriate resources to address delayed discharges. High bed occupancy and poor urgent and emergency care performance indicate that the NHS is running at its limits, with very limited capacity to absorb peaks in demand. 

The new Medium Term Planning Framework includes stretching targets for urgent and emergency care, particularly for waiting times in A&E departments. Making meaningful progress towards these targets will depend on trusts being able to address bottlenecks in how patients flow into, through and out of hospital. However no new measures have been announced to tackle delayed discharges – including no increase in hospital beds or increases in social care and intermediate care capacity. Failure to address shortfalls in capacity and to ensure all trusts have the necessary operational capability to use capacity effectively, will compromise the NHS’s ability to deliver on these bold targets.

Long-term solutions will include both sustained investment in NHS resources, social care and intermediate care, as well as putting in place the right processes to ensure their effective use. Better data on intermediate and social care capacity, as well as robust evaluation of various interventions to improve discharge delays, are also sorely needed to ensure that discharge delays finally improve across NHS trusts.

Acknowledgements

We are grateful to Hannah Maconochie for her early work on this piece, and to Freya Tracey and Jay Hughes for quality assuring the data analysis.

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