NHS urged to do more to help patients leave hospital safely
Healthwatch England's research
Following their work with the British Red Cross in 2020, they conducted a survey this autumn to learn about people’s recent experiences of hospital discharge.
They heard from 583 people (including 175 carers) who have been through the hospital discharge process in the past 12 months.
Key findings
- 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 experience.
Healthwatch England's call for change
Health and care leaders must see hospital discharge in the context of the whole health and social care system.
The Government should provide additional resources to support NHS and social care teams to ensure discharge procedures are closely followed, even during times of pressure. People tell us that when this doesn't happen, they require readmission or turn to other services, such as GPs, for support.
Healthwatch is calling for:
- 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.
Key themes in the research
In addition to the questionnaire, which provided HWE with the above data, they analysed more detailed stories from 430 people, shared either through a webform or a local Healthwatch branch. The stories helped them identify the following themes:
- When hospital discharge works well
- Delays to leaving hospital
- Leaving hospital
- Leaving at the right time
- Transport arrangements
- Ongoing support
Alan Boyd, CEO of Healthwatch Brighton & Hove said,
“In 2019, Healthwatch’s Michelle Kay, led a project speaking to patients about their experiences of being discharged from hospital.
At that time, 59% people felt they were not involved or only partly in decisions about their care; 39% felt the advice they had received while in hospital was not good enough to prepare them for being at home and 44% of all patients felt they were either not ready or only partly ready to return home.
Four years on and the results from Healthwatch England’s latest research shows that little has improved. Last month, we heard from a patient whose partner had to leave school to collect him from hospital and travel home to obtain measurements for the equipment he needed – why wasn’t he asked to collect this data before being admitted, to speed up his discharge?
NHS Sussex is looking at ways to improve the discharge process and Healthwatch is involved in this vital work. We will be making it clear that conversations and planning about discharge should happen as soon as someone is admitted, fully involving both the individual and their carers or family members.
Effective discharge ensures that people feel prepared to return home, safe in the knowledge that the support they need will be available.”
