‘Discharge to assess’ model
Last year the Government introduced a ‘discharge to assess’ model to free up thousands of hospital beds and cope with demand at the peak of the COVID-19 pandemic. This meant people were discharged from hospital faster by having their ongoing care needs assessed at home.
Working with British Red Cross, we published a report which drew on the experiences of nearly 600 people who left hospital during the pandemic. Although people praised hardworking staff for providing high quality care in difficult times, we found that the guidance wasn’t implemented consistently.
The majority of those who shared their experiences with us said they hadn’t received a follow-up visit and assessment at home, whilst some were discharged at night without any transport arrangement in place.
Thanks to your feedback, we were able to share with the Government how the hospital ‘discharge to assess’ model worked for you and made a number of recommendations to improve it.
What people told us
Together with the British Red Cross, we spoke to over 500 patients and carers and conducted 47 in-depth interviews with health and care professionals involved in the hospital discharge process.
The updated hospital discharge guidance makes improvements on a number of issues we raised on your behalf, including:
- Patient safety first. The new guidance emphasises that people should not be discharged at night and that people should always be informed about the next stages of their care.
- Simple discharge doesn’t mean no support. Even if someone leaving hospital doesn’t need a formal assessment for a care and support package, they can benefit from informal community support.
- Signposting. Signposting people to relevant voluntary or housing sector partners for help in day-to-day tasks and clarity on who is responsible for this.
- Holistic welfare checks. Everyone leaving hospital will 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".
- Involving and assessing the needs of carers when discharging patients.
- Designated care when people leave hospital. Arranging medication supply and transport home by the case manager before you are discharged home
- Clarity over staff roles. Greater clarity as to who is responsible for each step of the process and staff arrangements. This should further improve co-working and data-sharing between health and social care services.
Naomi Phillips, British Red Cross director of policy and advocacy said:
“We’re really pleased these recommendations have been included in the updated policy. The changes are based on real-world examples of what people need, using feedback from patients, healthcare workers and families. Simple things like holistic welfare checks and making sure people know who to contact if their condition worsens will make a difference to people’s recovery and give peace of mind to discharge staff too.
“We see through our Red Cross services at hospitals how factors like financial or social issues affect health outcomes when people return home, so this is a real step forward. It is critical that Government commits to continuous funding beyond September to ensure that this hospital discharge policy can be effectively implemented.”
Imelda Redmond, National Director at Healthwatch England said:
“Working with the British Red Cross we saw first-hand the challenges that many people faced after leaving hospital, such as health deterioration, feeling unsafe and readmissions."
The new guidance is here to stay. However, there’s a question mark over future funding for hospital discharge services. Since March 2020, the NHS has funded post-discharge recovery support for up to six weeks to ensure the model is swiftly implemented. Currently, this funding is due to end in September 2021. In the coming weeks, we will be raising the importance of ensuring that funding changes do not reverse progress towards a community-centred discharge model.