There is no doubt that delays in arranging follow-on social care are causing more older people to be stranded in hospital. But a new analysis of the problem says shortage of district nurses is at least as big a factor.

The number of district nurses in the UK has plummeted by 44% since 2010 when counted as full-time jobs, according to the analysis of NHS data by consultancy Christie & Co (pdf).

The trend is described as a “key trigger” of hospital admissions of older people and of subsequent delayed discharge. District and other community nurses play a crucial role in treating people in their own homes or in care homes when they might otherwise be referred to hospital.

Since 2008, numbers of people aged 60 and over admitted to hospital have soared 65%, the analysis finds.

Michael Hodges, head of care consultancy at Christie & Co, says ministers are missing the bigger, more complex picture behind delayed discharge by focusing narrowly on blockages in the social care system.

“We need to take a much more rounded view of the whole health and social care system,” he says, “including workforce planning for essential roles like district and community nurses and a proper assessment of what more social care providers could offer to ease pressure on hospitals.”

According to a breakdown of delayed discharge figures by Christie & Co, some of the areas said by the NHS to have the worst problems have ample capacity in local care homes to accept older people from hospital for short-term “reablement”.

Homes in Birmingham, which is said to have the biggest delayed discharge challenge, are shown to be operating at only 77.5% capacity. Those in Hampshire, which is said to have the second most severe problem measured by number of days of discharge delays, are running at 84.2%.

“There are great opportunities – and not just for a quick fix,” says Hodges. “I really hope that somehow the politicians look at it properly and strategically for the long term.”

The analysis includes a survey of fees paid to care homes for state-funded residents by 123 English councils, four in five of the total, plus figures for fees charged by more than 200 care providers.

On average, “base” fees offered by councils are shown to have increased by 3%-4% this year. But providers have been able to negotiate better terms for care of older people, with an average uplift of 5.2%.

By contrast, fees for “specialist” care such as learning disability or low-secure accommodation have risen by only 1.9% on average – the second successive year to show such disparity.

Hodges says providers are starting to think twice about investment in specialist care and suggests policymakers need “urgently” to look at funding for this part of the social care sector.

The survey confirms a continuing trend of care home providers squeezing self-funding residents, with an average fee increase of 6.3% for private payers and as big a rise as 9.8% in one case.