Plans announced to reduce delayed discharge

New campaign aims to reduce lengthy hospital stays

Published on 12th September 2019

Health staff are being encouraged to get patients out of hospital beds earlier as part of the NHS Long Term Plan.

NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning recovery care for patients following an operation or illness, as part of a campaign – called ‘Where Best Next?’.

The scheme - which aims to see around 140,000 people every year spared a hospital stay of three weeks or more - is not only better for individuals enabling them to get home earlier with the right support, but it could also free up more than 7,000 beds for other patients.

NHS medical director, Professor Stephen Powis, said: “I know how hard frontline NHS staff and their council colleagues have worked hard over the last year to reduce delays in discharging patients, but we want to ensure that all patients benefit from the shortest possible stay on a ward, getting home as soon as they are fit to leave with the support they need.

“Not only is that better for them, reducing the risk of infection or loss of mobility for older people in particular, but it also means that more beds are available for others who need care too, easing pressure on A&E and other parts of the system," he added.

Around 350,000 patients currently spend more than three weeks in acute hospitals each year. Many of those are older people who are often frail, and while a short period of treatment in hospital is sometimes necessary, staying too long can leave them vulnerable to infections or deconditioning.

More than one in three 70-year-olds experience muscle ageing during a prolonged stay in hospital, according to research and this rises to two thirds of those aged over 90, which can leave some permanently less mobile or able to perform tasks they could before.

As part of the campaign, posters and other information will be placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community.

The number of spells whereby patients spend longer than three weeks in hospital beds has reduced by almost one in ten in 2018-19 compared to the previous year.

As well as meaning that patients could recover in the familiar surroundings of home, this also freed up the equivalent of almost 1,800 hospital beds for use by other people who needed urgent treatment or to recover from a planned operation.

Separate figures on delayed transfers of care, which measure the number of extra days someone spends in hospital after they have been declared medically fit to leave, show that in June an average of 4,500 people each day were experiencing such a delay – down almost a quarter from the same month two years ago.

NHS leaders now want to quadruple progress on delivering shorter stays.

Caroline Abrahams, charity director at Age UK, said: “Reducing the length of stay in hospital is crucial to an older person’s well-being and ultimately helps them regain their independence more quickly when they return home.

“That’s why it’s very important that older people are able to leave hospital as soon as they are medically fit. A swift discharge is only possible by having a discharge plan in place on admission which is shared across organisations. Most importantly, there must be joined up services to fully support people at home when they are discharged to keep them well and avoid readmission," she added.

The campaign, developed in partnership with Royal Colleges, the Local Government Association and patient groups like Age UK, will therefore focus on reminding ward staff of five principles when planning care:

- Planning for discharge from the point someone is admitted, and ensuring that plan is shared with the whole team and the patient;

- Involving patients and their families in discharge decisions, and telling them the benefits of leaving hospital at the right time;

- Identifying frail patients as soon as possible and making a specific plan for their care;

- Having weekly multi-disciplinary team reviews for all long stay patients, and;

- Encouraging a ‘home first’ approach, including assessing people at home where possible.

Other measures are being introduced across the health service as local areas set about delivering the NHS Long Term Plan, such as community response teams providing proactive support to keep people well at home, same day emergency care units providing rapid tests and treatment for common conditions without the need for an overnight stay, and digital tools to speed up finding care home places for those who need extra support after spending time in hospital.


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