Our position on safe hospital discharge
In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who needed out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital.
Government has since updated this policy several times.
What we’re calling for
After assessing how the new policy was affecting people's experience of leaving hospital, we called for the following:
- The Government to update its hospital discharge and community support guidance. It must include new minimum standards on transport waiting times and post-discharge contact times.
- Integrated Care Boards (ICBs) to be consistent in implementing the latest hospital discharge guidance, including:
- Supporting people to make informed choices by providing contact information and advice and asking about transport home.
- Better signposting to support services, including voluntary organisations and services that support unpaid carers.
- Dedicated staff who will make travel arrangements.
- Points of contact for people to use if their condition gets worse.
- Greater involvement of family and carers in decisions about people discharge.
- Urgent Government reform of the social care system to ensure councils and providers have the staff, skills, and resources to support people to live independently, including reablement support at home or in residential care following discharge from the hospital.
- ICBs to focus on workforce solutions in secondary care, including a review of staff retention policies and the development of plans to increase the capacity of administrative staff in local NHS trusts. Admin staff should act as points of contact for those coming into and leaving the hospital and support the work of 'transfer of care' hubs
- NHS Digital to capture and report data on deterioration in health at seven and 30 days after discharge, to understand where discharge processes are not always working for patients. This includes collecting data on emergency readmissions, death after discharge, and contact with another health service about the same condition.
Our evidence
To understand the impact of the new hospital discharge policy in 2020, we spoke to over 500 patients and carers and conducted 47 in-depth interviews.
We found significant positives to the new discharge process for staff and patients, particularly better joined-up working between health and social care services. The national policy helped to reduce bureaucracy by encouraging services to quickly set up discharge services according to a single standard model.
However, we also found that the discharge policy wasn’t always working how it should on the ground.
- 82% of respondents did not receive a follow-up visit and assessment at home and almost one in five of these reported an unmet care need.
- Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital.
- Over a third (35%) of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance.
In 2023, we looked again at what people are telling us about leaving hospital:
- Over half, 59%, of people said the hospital discharge team didn't ask if they needed support in getting transport to the place they were discharged to, contrary to government guidance.
- People discharged either in the early hours, before 9 am, or late, after 6 pm, were significantly less likely to be asked if they needed transport.
- Over half, 51%, of people weren’t given contact information for further help or advice when leaving the hospital, contrary to government guidance.
- Nearly a third, 32%, felt unprepared at discharge.
- Carers were more likely than patients to say they didn't feel prepared at discharge (44% of carers, 25% of patients).
- Over one in ten, 11%, had to wait over 12 hours after being told they were well enough to leave the hospital.
- Over one in five, 24% reported an excellent hospital discharge experience, with 37% reporting either a mixed or neutral.
Our work
Our recommendations in 2020 led to an updated national hospital discharge policy, including:
- Emphasising that people should not be discharged at night and they should always be informed about the next stages of their care.
- Even if someone leaving hospital doesn’t need a formal assessment for a care and support package, they should be signposted to informal community support.
- Everyone leaving hospital should receive a holistic welfare check to determine the level of support, including non-clinical factors, such as their physical, practical, social, psychological and financial needs.
- Better ways of involving and assessing the needs of carers when discharging patients.
- Greater clarity on who is responsible for each step of the process and staff arrangements, aiming to further improve collaboration and data-sharing between health and social care services.
When centralised NHS funding for hospital discharge was set to expire in 2021, we called for an extension with the support of eight other national organisations. This helped secure £600 million Government funding for another year.
And following our latest research, we hope to see more positive changes to help people leave hospital safely.
