The closure of care homes, a lack of planning by hospitals and a shortage of further NHS care were blamed yesterday by the National Audit Office (NAO) for delays in discharging patients even though they are well enough to leave.

While most wait only a few days for discharge, more than a third are kept in hospital for more than a month, at considerable expense. The NAO estimates that delayed discharge (bed blocking) costs the NHS in England £1 million a day.

Edward Leigh, chairman of the Public Accounts Committee, described the situation as intolerable. The mostly elderly patients were “trapped in hospital simply because the public services cannot get their act together”, he said.

The report says progress has been made towards reducing the scale of the problem in the past few years, but that more needs to be done. More hospitals should start discharge planning sooner, it says, and more effort should be made to identify the obstacles to discharge.

Legislation currently going through Parliament will provide for social services to be fined if, by failing to provide sufficient places, they are responsible for bed blocking.

• Every NHS patient needing surgery will be able to choose between at least four hospitals under plans to increase choice within the service, Alan Milurn, the Health Secretary, announced yesterday. Within three years every GP will have to offer his patients a choice of four or five NHS and private hospitals. Patients will also be allowed to register with a GP near to their work rather than their home.

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