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Why hospital discharge is everyone’s problem (and how new plans can help)

When discharge goes wrong, it comes at a cost to the NHS, to social care services, and to the individual. When it works, people are able to move on with their lives and recover safely.

Progress so far

A lot has changed, both at a national and local level, since we published Safely Home, our report on delayed discharge, in 2015.  We explored the impact of delays on people and their families, as well as initiatives helping to address this issue across the country. Delayed discharge from hospital figures (often called Delayed Transfers of Care, or DTOCs) have continued to rise, in spite of efforts to share good practice across health and care organisations. The Care Quality Commission and Age UK, amongst others, have identified a developing ‘tipping point’ in the social care sector if a range of issues, including funding, are not addressed quickly. This is a concern, not least because of the impact that this has on people being discharged from hospitals and their families.

Addressing the issue together

There is, unfortunately, no easy fix. The issue of sending people home from hospital is a complex one, as it involves lots of people having to work together from different organisations. Hospitals that find themselves with beds occupied by people well enough to be discharged but unable to go home cannot solve the problem in isolation; nor can social care providers shoulder all of the blame. Whether a result of a wait for medication, a failure of communication between health and care providers or else simply because there is nowhere for them to go, delays to discharge are everyone’s problem. 

This is just one reason why we are partnering with the King’s Fund to deliver a conference today, looking at how we can work together to improve discharge. It’s really positive that so many people across health and care are ready and willing to look at the issue together. 

How Sustainability and Transformation Plans can help

The introduction of Sustainability and Transformation Plans (STPs) could provide a great opportunity for people to work more closely. STPs are a new approach to ensuring that health and care services are planned around the needs of local people rather than by individual organisations. A number of STPs have put discharge at the heart of their plans to make sure that they work together and get things right for patients in the future. They’ll also give people running services the opportunity to think differently about the way they work, with an increased emphasis on making sure the public are at the heart of care. 

This opportunity to change working practices that cause delays to discharge is already being taken advantage of through the use of the Red2Green approach. This initiative aims to reduce the number of ‘red days’, when patients spend days in hospital that do not directly contribute towards their discharge, and replace them with ‘green days’, which help people get home, by people working better together. Red2Green aims to ensure that everyone, especially the person receiving care, understands the next steps and knows that the system of care aims to reduce lost time and put the right support in place.

Putting people at the heart of change

Of course, listening to and learning from people’s experiences will provide the best measure of how discharge is working. That’s why we believe that patient experience of discharge is an excellent way to assess progress in health and social care integration. Patient experience of leaving hospital, and the care and support they receive afterwards to help them recover, provides real insight into how well services are working together, how efficient the local system is and the extent to which it is patient-centred. STPs are ideally placed to help deliver this. 

While discharge is everyone’s problem, we know that by sharing our experiences and learning together, we can help improve it.


What is your experience of hospital discharge?

If you've got an experience to share, get in touch with your local Healthwatch. 

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