NHSE’s urgent and emergency care plan: Improving discharge without increasing beds

Last week, NHSE published its strategy to recover and reform urgent and emergency care. The plan sets out key actions for coping with immediate pressures and stabilising the future.

The plan pledges to:

• Grow the workforce
• Allocate £1bn to providing extra hospital capacity, equating to 5000 new beds
• Allocate £1.6bn to speed up hospital discharge by developing care transfer hubs and new approaches to step-down care

The hospital discharge process is complex and multifactorial. Relying on more staff and more beds risks suggesting that this alone will be enough to sustainably reform discharge processes. However, delayed discharge isn’t solely caused by lack of staff or lack of beds, but also through ineffective processes. To tackle discharge delays, we need to recognise and understand the root causes and make better use of the resource we have, otherwise the extra beds provided will be quickly filled with new patients waiting to be discharged.

Our research found that there are 31 separate tasks and contact points involved in getting medically optimised patients out of hospital – these include completing paperwork, arranging transportation, and approving funding. Almost half of hospital workers and more than half of social care workers surveyed agree that administrative processes cause discharge delays. In 31% of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised. 18% of staff agree that patients have no clear discharge plan at admission, despite this being included in NHS discharge planning guidance. Additionally, 50% of hospital staff agree that resistance from family and carers to the final discharge decision causes delays, which can be mitigated through earlier and more effective communication.

Service redesign is needed, and from our 20+ years of experience partnering with the NHS to improve discharge processes across the country, we know that a successful discharge involves:

• Discharge planning as soon as patients are admitted
• Having dedicated resource for communication with all parties, including families and next of kin
• Using technology and digital processes rather than relying on paper
• Dedicated case management from admission to the hospital back door across all steps in the process
• It is positive that hospital discharge is getting more focused attention and dedicated resource from the government and NHSE. However the insight and experience available through dedicated resources, effective collaboration, and partnerships shouldn’t be underestimated allowing key clinical staff to focus on patient care.

Or contact: Maria Knowles (maria.knowles@xylaservices.com) or Lucy Chapman (lucy.chapman@xylaservices.com)