The process of moving between hospital and community-based care, whether it be another NHS service, social care or family and friends, tells us a huge amount about how integrated things feel from the patient’s perspective.
The subject of hospital discharge is therefore one that the Healthwatch network has covered on several occasions in recent years.
In 2015 we published our study of over 3,000 people’s experiences of leaving hospital to find out what was working and where things could be improved.
In 2017 we produced a follow-up report and took a deeper look into those who were being rushed back into hospital following a recent stay. We wanted to know what else could be done to make sure everyone gets home safely from hospital.
At the heart of both reports, we concluded that national leadership was a key part of the solution. So, with the new national guidance in place, we are keen to explore how this is working for people.
What were people experiencing before?
We know from our previous work that the five most common reasons the discharge process goes wrong is when:
- There is a lack of coordination between services – including within the hospital teams themselves or between the hospital and other parts of the system such as transport, social care and GPs.
- People feel stigmatized by their condition or circumstance - e.g. older people, people with mental health challenges and those experiencing homelessness made to feel as though they are a burden.
- People don’t feel involved in decisions about when they are going to be discharged or where they are to be discharged to.
- People are left feeling without support - so even when support is technically available it doesn’t feel like it because it has not been clearly explained.
- People’s full range of needs not being considered or met – including basic things like whether or not they have working heating at home, or if there is any food in the house.
Since our 2017 report we have seen clear improvements in things like reduced ‘delayed transfers of care’ and the increasing use of ‘discharge to assess’. But has this improved things for patients?
To bring our understanding up to date, we conducted a rapid review of eight local Healthwatch reports produced on hospital discharge during 2019/20. These brought together the views and experiences of 332 patients and staff, and found that people continue to report very similar themes as before.
What does the new rapid discharge guidance say?
The new rules brought in earlier this year were designed to get people who are medically fit out of hospital as soon as possible. This was to free up at least 15,000 beds across the NHS to help cope with the influx of COVID-19 patients.
For the period of the pandemic:
- Anyone who is judged to be medically fit should be discharged and have left within two hours.
- Hospitals are no longer expected to conduct assessments of continuing healthcare needs. Providers of community health services are instead leading on assessing and provider care for patients once they are home.
- Community health providers are expected to set up a new discharge service operating seven days a week.
- For most patients, this will mean that on the day of discharge or the day after, they will be visited in their home by an appropriate professional who will arrange the necessary support for them.
- For a small number of patients whose healthcare needs mean they can’t return to their home (around 5%), a care home bed will be arranged. These patients will be placed in the first available bed and supported to move to their preferred care home when a space becomes available.
- The NHS will fully fund the cost of this service. Additional funding is being released by the government to cover these costs.
We are interested to see how these changes have affected the way services are working together. We want to know if the ending of some of the more bureaucratic process has made things better for people? Likewise, we want to find out how limiting patient choice has affected people’s experiences.
Our research and how you can help
We want to understand how the new rapid discharge arrangements have worked locally.
Over the next four weeks we are going to be testing whether what’s set out in national guidance is really what’s happening on the ground and how it’s working for patients. To do this we will be working with the Healthwatch network and partners to gather stories from more than 1,000 patients, families and carers about their experiences of the discharge process during the pandemic.
Through interviews with staff, we’ll also seek to understand how challenging it has been to implement the new guidance so quickly, what impact it has had on their ability to deliver what’s expected of them, and how much of the new procedures we should be looking to keep as we figure out what the “new normal” is.
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