Children waiting to leave hospital – Children with a different status
TwMCThe Children’s Commissioner for England published a report called Children waiting to leave hospital. It looks at what happens when children are kept in hospital long after doctors say they are well enough to go home. The report shows that this is happening to hundreds of children across England, because the right support simply isn’t in place outside the hospital. Problems with housing, care packages and delays between different services mean that, for some children, hospital becomes the place they live rather than a place they visit.
The report shines a light on something we see every day in our work: children from the most disadvantaged families are hit the hardest. Some children are left stuck because care can’t be arranged without a stable or suitable address, even when everyone agrees they should be at home. Others are waiting for the provision of care packages and other specialist support.
The report highlights clear findings in respect of race and ethnicity. Children from Black and Asian backgrounds are more likely than white children to experience long hospital stays. These patterns reflect wider inequalities beyond healthcare, including poverty, insecure housing and barriers to accessing support. It’s findings mirror what we see, where exclusion and insecure status combine to make it harder to leave hospital.
Our work in this area
We have a growing area of practice working with medically vulnerable children. This includes our referral pathway with Young Lives vs Cancer in London and the South East. We also work with and receive referrals from several specialist hospitals for children.
Our work in these area draws on our main projects around anti-destitution casework, more intensive family support and support accessing specialist immigration advice. We work closely with healthcare professionals from these settings in planning and direct work with families impacted by this issue.
Examples from our casework
Toddler C
A toddler with complex medical needs was ready to be discharged from hospital but remained admitted because there was nowhere safe for them to go. Their family had had no recourse to public funds and an insecure status. Accommodation and support was initially refused by the local authority responsible, with an argument about which local authority should take responsibility. The child was going to be discharged from hospital oxygen dependent.
Discharge could not go ahead because care services could not be arranged without appropriate housing. Different agencies accepted that the child should not remain in hospital, but no single body took responsibility for resolving the situation quickly. The hospital social worker in this case had already referred to the local authority and received a refusal to assess and provide interim support.
Together with Migrant Children supported the family by coordinating between hospital staff, the local authority NRPF team and the local authority, ensuring the child’s medical needs were properly evidenced and advocating for suitable accommodation so discharge could finally take place. The case required referral to solicitors to engage in pre-action with the local authority in question.
Child E
A child receiving hospital treatment for cancer was medically fit for discharge, but the family were unable to leave because asylum support arrangements were unsuitable. The accommodation they were living in was communal and not suitable for an immunocompromised child.
The family experienced months of delay. Together with Migrant Children worked alongside hospital professionals to evidence the medical need and support the family in challenging the Home Office’s provision of accommodation and on-going delay in providing safe accommodation, challenge incorrect decisions, and escalate safeguarding concerns. This advocacy led to new accommodation being provided that met the child’s medical needs.
Child S
A secondary school‑aged child undergoing treatment for a serious illness required isolation following hospital care because of a compromised immune system. The family were living in asylum accommodation that was overcrowded and affected by damp and mould. Medical professionals were clear that returning the child to this environment would pose a serious risk to their health, making discharge unsafe.
Despite agreement from clinicians, the family faced significant delays in securing alternative accommodation close enough to the hospital for ongoing treatment. During this time, the child’s parent was living full‑time in hospital while trying to care for other children elsewhere. Together with Migrant Children supported the family by gathering medical evidence, liaising with the Home Office and asylum support providers and supporting the family though the pre-action process, making the case that suitable housing was essential to the child’s recovery. This work focused on ensuring that immigration status did not become a barrier to the child’s right to recover safely at home.
What our data tells us
On average, from us accepting a case involving a ‘stuck’ discharge – It takes on average about 8 weeks to resolve. This is extended to 12 weeks where the family is from an asylum seeking background.
The vast majority of cases we deal with where the child is unable to leave hospital is due to support provision, broken down as follows in the last 6 months.
| Immigration position | Main issue | Percentage of cases (rounded) |
| Asylum Seekers / Refused Asylum Seekers | Support not being provided by the Home Office already. | 5% |
| Asylum Seekers / Refused Asylum Seekers | Support already being provided is not suitable. | 40% |
| Pending or soon to be ‘family’ application | No support in place – New applications for section 17 support | 15% |
| Pending or soon to be ‘family’ application | Support / Assessment under S17 already refused when referred by health professional. | 20% |
| Pending or soon to be ‘family’ application | Section 17 support already being provided is unsuitable | 5% |
| Work/Study visas | Support not already being provided – A serious diagnosis has meant a family has had to reduce / stop work. | 10% |
| Work/Study visas | Support refused – A serious diagnosis has meant a family has had to reduce / stop work. | 5% |
The vast majority of cases we deal with in this area concern families seeking asylum and those with more complicated immigration situations, with a smaller number who are on work/study visas and a child with a serious medical problem means that the family is unable to work, or needs to reduce the amount they work, leading to them struggling to meet a child’s needs in terms of finances / suitable housing.
What families tell us
Families generally report finding the additional stress of support entitlements both complicated and very stressful. In particular, the majority of cases involving asylum support families had already submitted letters and medical information from hospitals, but were not being responded to, or their cases addressed in a timely way. The majority (around 70%) of these cases require escalation to pre-action in order to resolve the housing issue underneath, predominantly due to delay.
Families in the asylum system particular describe feeling ignored, or not listened to in response to their child’s medical needs. For one family, it took 5 months from when they first submitted additional evidence to the Home Office, to the Home Office acknowledging the evidence and providing a decision on a request to remain in a particular area. Once there was an advocate involved in their case, it was resolved in only a couple of weeks.
When dealing with asylum support again, the gap between receiving a decision that support should be changed, the delay waiting for suitable accommodation to be identified by providers is often too long. Families describe the short notice, inability to view accommodation to ensure suitability for their child and sudden moves from accommodation as incredibly stressful and worrying times for them.
Families also report finding the process of assessment for Section 17 support is really challenging in this context, when they are already dealing with what are often significant medical needs of a child. The focus in some cases of NRPF provision where Section 17 (children’s services support) was the option the parents felt were on them, their status and their finances, and less about the welfare needs of their children.
Summary
In summary, there are numerous issues and barriers that impact on children leaving hospital when they are subject to NRPF, eligible for asylum support or have an insecure status. The entitlements in this area are more complicated, and delays and processes in these systems are not led with the welfare of the child at heart. This ultimately culminates in delays for children leaving hospital. We know from all available evidence that children who are discharged from hospital have better outcomes than those who are stuck in hospital for long periods of time.
Specialist intervention, like that provided by our service, seems to reduce the time children spend in hospital. Many of the practitioners we work with voice frustration around the process and many families confused and feeling not listened to. Specialist advocacy should not be necessary to secure the right outcome for a child with a serious medical problem and services / support provisions, need to be more accessible and have the right processes in place to engage with cases involving medically vulnerable children.
Children and families in this area need a holistic approach to casework that also includes referral to specialist immigration advice. Entitlements in this space are often tied to what is happening with someone’s immigration and it is necessary to seek specialist advice in this area, to enable short, medium and long term planning for medically vulnerable children.
