Newton: Finding a Way Home - how health and social care can optimise hospital flow and discharge this winter

This County Councils Network report, produced with Newton, examines why hospital flow and discharge for older people remain under severe strain despite repeated national interventions.

The analysis shows winter pressures are not solely the result of adult social care capacity, but stem from systemic issues across health, community services and wider public systems.  

The study argues that improving outcomes for people and for systems requires a person‑centred, whole‑system approach that both prevents unnecessary hospital use and ensures timely, well‑supported discharge that maximises independence.

It finds that a high proportion of hospital activity is avoidable:

• ‍‍31% of A&E attendances and 30% of admissions for older people could have been managed in the community.
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• Length of stay has risen sharply, with older adults spending 35% longer in hospital than before the Covid-19 pandemic.
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• Only 12% of older people in short‑term beds are discharged on time, leading to deconditioning and avoidable long‑term placements.
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• Between 20% and 45% of older people are discharged onto what the researchers suggest are ‘suboptimal pathways’, often reducing long‑term independence.  

Recommendations for government include:

• Expanding home‑based reablement and investing in the therapy workforce.
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• Prioritising the avoidance of unnecessary admissions  
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• Moving to multi‑year funding and strengthening commissioning capability.
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• Building capacity across intermediate care, optimising discharge processes, and developing targeted prevention strategies, including a national approach to dementia care.

Recommendations for councils include:

• ‍‍Improving data sharing, developing a national performance framework, and improving visibility of community services.
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• Building capacity across intermediate care, optimising discharge processes, and developing targeted prevention strategies.