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From hospital to home: Improving patient discharge

Every winter, the NHS is under pressure to free up beds. However, getting hospital discharge wrong can harm both patients and services. Healthwatch England looked at what people have told them about leaving hospital, and the lessons the NHS can learn to improve the support patients get.

In 2023, Healthwatch England’s research found worrying problems with people’s experiences of hospital discharge. People said the NHS didn’t give them proper support or information. Two years later, a review of people’s experiences of hospital discharge indicates that many of the same problems are still occurring.

Why safe hospital discharge matters

When the NHS correctly discharges patients from a hospital to their homes or another care facility, it can aid their recovery and free up beds for new patients. But for this to happen, hospitals are supposed to ensure that patients:

• are medically fit to leave the hospital
• have the information they need
• have any care and support they need in place
• are involved in the planning.

However, getting the discharge process wrong causes problems for both the patient and services. If patients are discharged too early without proper support, they may have to be readmitted to a hospital or seek help from GPs or pharmacies.

Meanwhile, delays in discharging medically fit people create issues for new patients needing beds, leading to longer wait times in A&E and treatment in corridors until beds are available.

The importance of being involved in plans

NHS guidance on hospital discharge states that the NHS should support patients and their relatives and carers in making fully informed decisions about the care and support they receive on discharge from a hospital, where appropriate.

However, people have told us about not being involved in discharge planning and the inappropriate decisions this can result in. Examples include:

• Hospital staff taking patients with dementia at their word when they say they don’t need support at home.
• Relatives not being consulted about moving patients to care homes when care packages were already in place.
• Hospitals assuming relatives could care for patients on discharge or transport patients home without checking first.

The consequences of poor timing

NHS discharge guidance states that people should be discharged to the right place, at the right time, with the proper support to maximise their independence and lead to the best possible outcomes.

However, we have heard about people leaving hospitals without everything in place. People have told us the NHS has discharged them:

• Before seeing a consultant
• Before being properly diagnosed
• Without any follow-up care in place
• Without medication or information about how to manage at home.

As a result, some people experienced severe consequences, including further medical complications. In some cases, the NHS had to readmit people to the hospital.

In other cases, people described their discharge as delayed as they had to chase up the hospital for information on self-care and medication or because they were waiting for social care. This can have knock-on consequences.

The importance of clear information

People have told us about being given poor or limited discharge information on how to cope once at home and how to care for themselves. We heard about:

• Information that was inappropriate to their needs or made outdated assumptions.
• A lack of or limited information on administering medication by injection or changing catheters.
• Discharge letters that gave inaccurate information about someone’s condition.

The impact of a good experience

Research from Healthwatch Oxfordshire found that people value support and care from health professionals, good communication, being involved in decision-making, and effective follow-up and aftercare.

Positive stories about discharge care include:

• Appropriate and helpful information on how to care for themselves.
• The post-discharge support they need, including equipment to help cope at home and visits from community teams.
• Support from voluntary organisations, including a home visit on the day of discharge.

Steps that will improve hospital discharge

Current winter pressures and the high demand for hospital beds result from multiple factors affecting NHS and social care teams. However, several steps could help ensure more people have a safer hospital discharge experience.

1. Follow existing guidance: NHS England’s next Urgent and Emergency Care Recovery Plan should ensure that Integrated Care Boards (ICBs) ensure that services follow existing hospital discharge guidance.
2. Review secondary care workforce: ICBs should also focus on workforce solutions in secondary care.
3. More resources for social care: The government has announced plans to review social care challenges. However, in the short term, more resources are needed to ensure that councils and providers have the necessary staff, skills, and resources to support individuals in living independently.
4. Better data on hospital discharge: To ensure people are not rushed out of hospital when they’re not ready and that processes are working for patients, we are calling on the NHS to restart the collection of daily emergency readmissions data and publish this data monthly. Minimum standards on transport waiting times and post-discharge contact times should also be introduced.

If you would like to share your experiences of hospital discharge please get in touch.