Getting hospital discharge right

Home to the unknown

The British Red Cross has a long and proud history of working in partnership with the NHS.

Day in and day out, our frontline staff and volunteers support patients in hospital emergency departments, provide ambulance support, help people get home from hospital, carry out home assessments and support older and vulnerable people to live independently at home.

Through this work we see some of the strains the health and care systems are facing, and the impact this can have on individuals. 

Our report Home to the unknown: Getting hospital discharge right (PDF) focuses on our research about patients’ experience of discharge from hospital and their transition from hospital to home. We believe that safe, well-planned discharge can make a big difference to an individual’s recovery, wellbeing and independence. 

We’re publishing this new research at a time of important change in health and social care, including the NHS’ compelling vision for a new way to address the kinds of issues we are raising, working across the complex systems of care in hospitals and through to the community. 

We support the clear ambition to embed a whole-person approach to health and care in the NHS and the forthcoming government green papers on prevention and social care.

• Read the full report (PDF)
• Read the England briefing (PDF)
• Read the Scotland briefing (PDF)
• Read the Northern Ireland briefing (PDF) 
• Download the five part independence checklist (PDF)
• View our recommendations

Key findings

In our day to day engagement, through our operations, we see many examples of good practice initiatives including Multi Agency Discharge Events (MADE), Discharge to Assess (D2A), Home First and hospital – or community-based hospital – multidisciplinary discharge teams. Many are working in successful partnerships with the voluntary and community sector. 

Across the UK, we see how these initiatives are making a real difference to the home from hospital experience.

However, although there are examples of excellence, our research findings show a lack of consistency of provision and that too many people are still falling through the gaps with unmet needs. People are entitled to expect holistic, person-centred care to support them in their transition from hospital to recovery, wherever they may live. 

Our research found:

• People are sometimes returned to homes inappropriate for their recovery, with no hot water or heating. Others with changing mobility needs reported struggling with a step up to a front door, or felt unable to get upstairs to the toilet. 
• Considerable variation in discharge practices and measurement of outcomes can have an impact both on patient experience and on clinicians’ ability to understand the impact of discharge on recovery.
• An especially persistent barrier to people leaving hospital when they were ready was ensuring the appropriate package of social care support was in place. In addition, many clinical staff and some social care staff are not aware of other non-clinical services, often offered by the voluntary and community care sector.
• Without appropriate support and communication throughout their journey through hospital and home again, people can feel unequipped and ill prepared to support their own recovery.

Our recommendations

Our proposals reflect the need to prioritise the implementation of a personalised approach to a person’s journey through hospital and home again, together with opportunities to relieve the pressure from hard working NHS and care staff. 

We believe there need to be clearer lines of accountability for ensuring a recovery-focused patient journey through hospital and home again, and that people’s non-clinical needs should have parity of esteem with their clinical needs.

In particular, based on our experience and our research, we would argue:

1. There is a substantial opportunity for commissioners and providers to harness the power of non-clinical support, including the voluntary and community sector (VCS), to relieve the pressure on the NHS and to create better outcomes for people and improved patient flow within and between health and social care providers. 
2. Every point of hand-off between clinical teams in hospital and from the hospital to the community is a potential point of success or failure for patient recovery. We recommend that there is a clinical responsibility to ensure the effective management of these transitions, so that there is continuity of care and patients don’t fall through the gaps between teams. 
3. We recommend that a five part ‘independence check’ should be completed as part of an improved approach to patient discharge – prior to discharge or within 72 hours of going home. This would help to inform the setting of a realistic discharge date and would include assessing:

• Practical independence (for example, suitable home environment and adaptations) 
• Social independence (for example, risk of loneliness and social isolation, if they have meaningful connections and support networks) 
• Psychological independence (for example, how they are feeling about going home, dealing with stress associated with injury) 
• Physical independence (for example, washing, getting dressed, making tea) and mobility (for example, need for a short-term wheelchair loan)
• Financial independence (for example, ability to cope with financial burdens)