Listening to what matters:
Placing people's needs at the centre of hospital discharge practice and policy in Wales
Exploring people's experience of leaving hospital in Wales.
Our new report, Listening to what matters: Placing people’s needs at the centre of hospital discharge practice and policy in Wales (PDF), explores patients’ and carers’ experiences of hospital discharge between May 2020 and October 2021, after the Covid-19 Hospital Discharge Requirements were published.
The British Red Cross has a long history of working in partnership with the NHS to support people when they are discharged from hospital. Through this work we have seen lots of good practice and how hard NHS staff and volunteers are working, especially during the Covid-19 pandemic.
This report provides evidence to support that practice, but also highlights where the discharge process is not meeting the needs of all patients and carers in Wales.
Through listening to what matters to patients, we have developed recommendations, that we believe if implemented, will improve the discharge process in Wales for patients, carers and professionals.
Key findings
- All of the professionals involved in this research were in support of the Discharge to Recover then Assess (D2RA) model with a collective agreement that patient outcomes tend to be better when they are able to recover at home.
- Many patients are not receiving information leaflets about the discharge process, or follow-up contact information.
- Many family members and carers reported not being involved in the hospital discharge process despite expressing a wish to be included.
- Pre and post discharge assessments are not being carried out where patients felt they had support needs.
- There is a lack of resources in the community. This includes social care, community services unable to run a seven-day service and barriers to the voluntary and community sector (VCS) providing support in the community.
Our recommendations
Our report makes recommendations which support the improvement and implementation of current guidance, and addresses the wider constraints on the hospital discharge system. In light of our findings, we have identified the five key recommendations below:
- Provide all patients with a leaflet about the discharge process when entering and leaving hospital, as stated in the current discharge guidance. This should be implemented by the hospital discharge teams.
- Improve communication with and involvement of family and carers. Ward staff should consistently involve family in decisions made during the discharge process. This includes carers, family members with lasting power of attorney or a nominated family member for dementia patients.
- Provide hospitals with the guidance and tools needed to better determine the most appropriate discharge pathway for patients. The Department for Health and Social Services should amend the national policy, or issue complementary guidance, to include a set of minimum standards for all patients being discharged. This should include patients on simple discharge, and advice for hospital staff on how to determine the appropriate discharge pathway for patients.
- Update current guidance to include checklists which can be used to ensure patients, families and carers have the support they need at home. The British Red Cross five-part independence checklist should be used by multidisciplinary teams to cover practical, social, psychosocial, physical, financial and other patient-centred needs.
- The Welsh government should invest in community-based support to address the gaps in provision, including at the weekend. This would better meet the increased workload and improve joined-up working between hospitals, community healthcare, the VCS, social care services and transport services.
Contact us
For more information, please email Georgia Marks, Policy and Public Affairs Officer (Wales): georgiamarks@redcross.org.uk
- Follow @RedCrossPolicy on X for more information about our policy calls
- For media requests please contact us on 07834 525650 or press@redcross.org.uk.