Majority of care providers want hospital discharge reform, report finds

More than nine in 10 care providers want to see an overhaul of the hospital discharge system, a new report has found.

The report, Hospital Discharge Report: Care Providers’ Perspectives, surveyed 568 care providers across the UK. It was carried out by Autumna, a directory of later life care providers. Key findings include:

• 1% of care providers would like to see government reform of the hospital discharge process
• 3% of those who say they have a positive relationship with their local hospital discharge teams still say they would like the process reformed
• 7% of care providers do not feel the hospital discharge teams understand the care they offer
• 5% of care providers say information provided by hospital discharge teams is not accurate
• 6% of care providers think the information provided by hospital discharge teams is insufficient to make an initial assessment on admission suitability

An estimated 85% of patients over the age of 65 experience a delay in discharge to care, the report says. This means that other patients often cannot access hospital beds – 150,000 patients had to wait more than 12 hours for a hospital bed after the decision to admit in the first quarter of 2024.

Customer is left ‘in the middle of red tape’

The delay in discharge also has an impact on the elderly patients forced to remain in hospital. This includes muscle wastage from lying in bed and a decline in patients’ ability to undertake everyday activities such as bathing and getting dressed. The estimated cost to the NHS of one night’s stay in hospital is £395, the report says.

The survey also asked respondents to name the reasons for delays in transferring patients from hospital to care providers. The main reason, cited by 203 respondents, was that funding was not agreed. This was followed by insufficient information (181), lack of communication (151) and transport not agreed (133).

One East Midlands care provider commented: “It’s just not collaborative and we don’t work as a team and the poor customer is left in the middle of red tape.”

Another care provider, based in Yorkshire and the Humber, said: “The information on discharge assessments is often wrong. Twice in the past couple of months we have had residents discharged to us who have been actively dying on arrival, both died within two hours of arrival, neither family was prepared for this and we were not expecting it. This has an impact on all of our staff and the time they have to care for other residents.”

The survey also asked about the referral process. Six in 10 respondents said they received referrals from hospital discharge teams, and of those, nearly one in four (23.8%) said they received them daily, while a further one in three (32.8%) said they received them weekly.

Nearly half (48.7%) said that they felt the discharge team didn’t understand what they offered, while 34% said that they didn’t feel they had a positive relationship with the discharge team.

Respondents were asked about the average length of time from first conversation with the discharge team to admission into their care. While a third (32.8%) said it was two days or less, four in 10 (42.8%) said it was three-to-six days, 17% said it was one-to-two weeks, and 7.3% said it was three weeks or more.

The report broke down responses by region. It found that the East of England outperformed other areas in terms of speed of discharge, but that there were “significant gaps in communication and information accuracy.” One provider in the region commented: “Very poor process, inaccurate discharge letters, no clear guidance on medication changes and transport issues. Delayed physical discharge although patient on the system shows as being discharged from hospital. However, they do not arrive in the care home until the next day, therefore for 24 hours they do not show as being in either facility.”