Trusts told: Forget the rules, get people out of hospital

The drastic measures include suspending all eligibility and funding decisions from the hospital discharge process and temporarily scrapping continuing healthcare assessments — a move which requires legislative changes but hospitals have been broadly told get on with anyway.

The new discharge criteria also mean patients must be discharged from hospital on a three-hour target: one hour from the ward to the discharge area and then discharged from the hospital within around two hours from then.

One senior policy expert told HSJ the guidance “basically amounted to orders which say: whatever it costs, get people out of hospital. Don’t worry about the rules, just do it.”

The person added: “Inevitably, some corners are going to cut and we may have to hold our nose a bit. But given where we are, that’s a price we’ll have to pay. 

“We aren’t going to have people discharged with fully evaluated assessments. We just don’t have the time to do that. We need front-line staff fully focused on treating patients.”

The measures, set out in guidance sent to trusts last week, are part of a £2.9bn package for the NHS and councils set out by ministers last Thursday. The money is from the government’s £5bn emergency coronavirus fund.

Several sources told HSJ they did not think ministers’ target for clearing the 15,000 hospital beds by Friday 27 March was realistic, especially with staff already facing shortages as some have been advised to self-isolate. But it was also argued the target was a useful means of stressing the level of urgency.

Trusts have been allocated £1.3bn of the total, with the rest going to councils, the vast majority of which will pay for social care. The package is part of the NHS’ overall goal of freeing up 30,000 beds ahead of the expected surge of covid-19 patients in the coming weeks.

However, significant tensions have already emerged between hospitals and care homes around patients who are ready to be discharged but have not been tested for coronavirus and also around personal protective equipment, as revealed by HSJ last week.

HSJ has been told care and nursing homes have refused to accept discharges unless the patient has been tested for the virus. Testing is not a requirement under the discharge guidance issued by the government on Thursday.