Work together to find solutions to the problem of hospital discharge

All of us operating in the health and social care sector are working hard to help people who are well enough to leave hospital return home and continue recovering in familiar and comfortable surroundings.

We have to work just as hard to get that process right.

Recently, I hosted our first Health and Social Care Leaders’ Summit where we discussed how best to support patients throughout the discharge process.

It’s a team effort and, as NHS Providers director of policy and strategy Miriam Deakin pointed out: “The NHS can’t do this alone. It’s all about collaboration with a wide range of local partners – social care, primary care, housing and, critically, the voluntary and community sector.”

We used this occasion to launch the British Red Cross’ new report Home to the Unknown: Getting hospital discharge right, which explores hospital discharge, the experiences of patients and the views of medical staff and policy experts from across the UK.

Range of issues

Patients tell how a range of issues – from people not understanding diagnoses or paperwork through to isolation, lost confidence or physical and practical challenges – can create barriers to recovery.

Evidence shows that staying in hospital longer than absolutely necessary can have a negative impact on health, leading to complications such as infections, muscle wastage, reduced mobility and depression

Our examination of more than 100 hospital discharge checklists used by clinicians in England to assess people before they leave hospital found that half of them don’t investigate a patient’s situation at home.

Is anyone there? Is there food in the fridge? Is the heating working?

Too often, we simply do not know.

Being sent home from hospital is usually seen – by patients and clinical staff – as a positive.

The patient has been treated and is able to return home while the hospital gets to free up a bed that can be given to the next sick patient who needs it.

Few enjoy staying in hospital with most glad to return to their routines, their own meals, the freedom to see friends and family outside prescribed visiting hours.

In fact, evidence shows that staying in hospital longer than absolutely necessary can have a negative impact on health, leading to complications such as infections, muscle wastage, reduced mobility and depression.

For staff, efficient patient flow is essential to the effective management of hospitals and the ability of clinicians to treat as many patients as possible.

Sometimes, however, the truth for patients beyond the hospital doors is complex – with complications like being unable to cook and clean or afford to heat the home – and people may be at risk of preventable readmissions where non-clinical care needs are not appropriately met.

We at the Red Cross know how tricky it can be to navigate hospital discharge but it doesn’t have to be this way and there are simple steps we can take to make a difference.

Straightforward measures

We are talking about straightforward measures that could improve patients’ lives while better enabling hospitals to discharge people with confidence.

The British Red Cross works in more than 100 hospitals providing assisted discharge services on wards and in emergency departments.

This winter we have worked with the NHS to provide additional or scaled up support designed to relieve pressure on hospitals.

We believe that five factors – physical independence, social independence, psychological independence, practical independence and financial independence – need to be properly considered alongside improvements to their condition

In Wales – where the Red Cross has been working with Welsh Government, NHS Wales and local health boards to provide support at seven emergency departments – we have assisted 25,000 patients since mid-December and enabled hundreds to return home.

We talk to staff and occupational therapists and hear that, thanks to the work we do to ensure people’s homes are safe and that individuals are given help to adjust and recover, our assistance offers peace of mind when patients leave hospital.

It often combats the risk of loneliness and isolation for the patient and enhances their ability to live independently.

Our report shows that for most patients aspirations on leaving hospital are modest and achievable.

Take Audrey, for example, who is aged 87 and from Wales. She had been admitted to hospital repeatedly with breathlessness, infections and sepsis and misses her hobbies of breeding Guinea pigs, gardening and building model houses.

Her recovery was hampered by mobility issues, financial pressures, a lack of close family connections and confusion about the long-term effects of her ill-health.

These considerations and a fear of returning to hospital have impacted on Audrey’s confidence and motivation to get better and live independently again.

Small improvements have been made – the Red Cross helped Audrey regain confidence following an earlier hospital stay – but more could be done if her ongoing recovery was better factored into the discharge process.

It is with the experiences of patients like Audrey in mind that our report recommends that five non-clinical considerations are examined when people are assessed for hospital discharge.

We believe that five factors – physical independence, social independence, psychological independence, practical independence and financial independence – need to be properly considered alongside improvements to their condition.

Where patients experience mobility challenges, isolation, stress, practical barriers that prevent them from getting out and about and financial burdens, their ability to get better can be compromised.

Our report recommends that support be provided to patients facing such challenges and we believe that care commissioners and providers can utilise non-clinical assistance, including that provided by voluntary and community sector organisations, to relieve pressure on the NHS and improve outcomes.

When medical teams in hospitals prepare patients for discharge, we recommend that they take clinical responsibility for managing the transition from hospital to the community and consider challenges that exist beyond the wards.

If we all work together on better managing this, we can help patients live healthily and independently at home and potentially reduce the risk of them returning too quickly to hospital.