They found levels have reached their highest level since national records began in 2016, and are once again rising after a brief post-pandemic dip.
The report describes delayed discharges as a “symptom of much wider challenges” facing Scotland’s health and social care system, including chronic workforce shortages, financial pressures on councils and integration authorities, lack of suitable housing and care provision, and complex, fragmented governance arrangements.
In 2024–25, 17,915 patients experienced a delayed discharge, accounting for 720,119 clinically unnecessary hospital bed days.
The report said: “People who are delayed in their discharge occupied approximately one in nine hospital beds in Scotland in 2024/25, considerably reducing the beds available for incoming emergency and planned patients.
“This adds to existing pressures in the health system, making it more difficult to admit patients, contributing to overcrowding in emergency and assessment units and increasing planned care waiting lists.”
The impact on individuals of a prolonged hospital stay can be severe, including increased risk of infection and physical deconditioning. It can also worsen mental health — particularly for older patients and those with dementia or frailty.
Patients aged 75 and over occupied 66% of all delayed discharge bed days.
The auditors also found significant regional differences.
Delays ranged from 5.8 per 100,000 population in Renfrewshire to 115.5 in Eilean Siar.
Audit Scotland estimates that a hospital bed costs an average of £618 per day, compared with around £145 for a publicly funded care-home place or £126 for residential care.
The reasons for delays vary, but the most common causes are a lack of available care-home places, delays in arranging home-care packages, and complex cases involving adults who lack capacity and require legal processes such as power of attorney or guardianship orders.
Audit Scotland notes that adults with incapacity often experience the longest delays, with between 35 and 65 people each month in 2024–25 remaining in hospital for more than six months because appropriate legal and care arrangements were not in place.
NHS Greater Glasgow and Clyde estimated that around a third of its delayed discharges were linked to patients not having a power of attorney, equivalent to several acute hospital wards being blocked.
The watchdog acknowledges that the Scottish Government, NHS boards, councils and integration authorities have all prioritised reducing delayed discharges in recent years, and that a range of initiatives are under way — including Hospital at Home services, “discharge without delay” programmes, rapid response support teams and new digital tools.
However, it concludes that there is little evaluation of these initiatives, making it difficult to judge what is working and what represents value for money.
And despite the scale of the problem, the watchdog warns that the true cost of delayed discharges remains unknown, with no comprehensive assessment of the knock-on impacts across the wider health and care system.
Audit Scotland is particularly critical of the lack of transparency and shared accountability across the system, with overlapping responsibilities between the Scottish Government, NHS boards, councils and integration joint boards complicating decision-making.
It warns that without significant progress in shifting care out of hospitals and into community and home-based settings, Scotland will struggle to cope with rising demand over the next decade.
By 2034 there will be almost 12% more people turning up at hospital unexpectedly — for example through A&E or emergency admissions — rather than planned operations or appointments.
Stephen Boyle, Auditor General for Scotland, said: “Delayed discharges from hospital have far-reaching impacts on people’s health and well-being. The Scottish Government, health bodies, councils and other partner organisations agree on the need for major changes and are actively trying to reduce delayed discharges.
“Now they must improve how they collect, analyse and use data to evaluate the initiatives underway to tackle the problem. Without this, it’s impossible to understand the impacts and costs of delayed discharges and whether the initiatives across Scotland are improving lives, services and delivering value for money.”
Scottish Lib Dem leader Alex Cole-Hamilton said the cost was “utterly astonishing”.
“The SNP’s abject failure to provide proper care at home or in the community is leaving 2,000 patients stuck in hospital on a typical night.”
The health lead at trade union Unison Scotland, Matt McLaughlin, said the Government’s “budget cuts and ongoing failure to get to grips with the social care crisis” were “causing real harm to patients”.
Scottish Labour health spokesperson Jackie Baillie MSP said the report’s findings were “staggering”.
“This issue is causing misery for patients, piling pressure onto hospitals, and costing our NHS billions.”
Colin Poolman, Executive Director, RCN Scotland, said: “It’s simply not possible to address the issue of delayed discharge in Scotland’s hospitals without increasing capacity in community and care-home settings. Delivering nursing care in the community is key, bringing care closer to the individual and reducing the pressure on acute hospitals.”
Health Secretary Neil Gray said: “We are grateful for Audit Scotland’s report and share the view that, despite the hard work this government has undertaken in partnership with Cosla and Health and Social Care Partnerships, more must be done to ensure people receive the care they need in the right place, at the right time.
“We agree that nationally consistent performance information is critically important for improving outcomes.
“Despite the challenges the report sets out, there have been improvements in some areas delivered through a whole-system approach to change and 97% of all hospital discharges happen without delay.
“Local systems have been working hard to reduce delays and deliver on the commitments set out in our Operational Improvement Plan, supported by investment of over £220m to improve patient flow, enhance capacity and remove blockages keeping patients in hospital longer than necessary.
“This winter, that includes up to £20m to fund increased social care and reduce pressure on the hospital front door.”