A newly published survey of hospital and social care workers shines new light on the underlying issues causing delayed discharge, with thousands of patients left stuck in hospital for an estimated average of 12 days despite record high waiting times for patients requiring care.
Conducted by CHS Healthcare UK, the survey reveals that almost half (43%) of patients on hospital wards across the UK meet the NHS’s criteria for hospital discharge, meaning they are well enough to leave hospital. With the NHS facing unprecedented pressures – from the COVID-19 pandemic to a workforce crisis – almost one in five hospital workers (17%) reported patient flow as the biggest problem they face.
Hospital workers went on to report that the top three reasons for these delays are complexity of patients’ needs (77%), no aftercare support available (55%) and resistance from patient’s family/carers on the discharge decision (50%). Almost half of hospital workers (49%) also reported that paperwork, admin and bureaucracy cause delays to discharge.
To avoid delayed discharge, government guidance states that ‘early discharge planning from admission is required’. However, the survey reveals that that in 31% of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised. The survey also reveals that two in five hospital workers (40%) are unaware of the government’s ‘Discharge to Assess, Home First’ guidance, which is designed to avoid delays in care discharge.
Care home staff and managers responding to the survey reported that the top three factors contributing to delays in discharge from their perspective are paperwork, admin and bureaucracy (54%), no clear discharge planning pathway (48%), and delays in agreeing funding (47%). Staff also added that better discharge planning prior to patients being medically optimised would benefit those who are transferred to additional care (75%).
Matt Currall, Managing Director at CHS Healthcare said: “With unrelenting pressures felt across the system, accelerating patient flow is the immediate and glaring opportunity to protect patient outcomes and create sustainably in the NHS. Our new insight shines a light on the issues faced by hardworking health and social care staff, and the urgent need to re-engineer processes and drive greater co-ordinated collaboration in order to create a system that truly meets the needs of patients.
“A system that works for patients needs hospital teams, social care services, families and providers working and planning together. Achieving this will increase capability through resource and scale, giving everyone the tools they need to make significant change.”
Liz Bruce, Joint Executive Director, Adult Social Care & Integrated Commissioning, Surrey, said: “Discharge is everybody’s business. It’s not just a section of the staff in the hospital or the discharge team in social care, it’s all our business. It can be challenging to take a whole system view and say to ourselves ‘where are the interventions that will make the greatest changes and what can we do together?’ It’s got to be done in collaboration and we all have to care about that patient journey."
Lesley Watts, Chief Executive Officer at Chelsea and Westminster Hospital NHS Foundation Trust, said: “We need strategic planning from ICBs for complex cases, such as for people with mental health or physical rehabilitation needs or need social care support. We’ve seen that when systems work together it can have a significant benefit for patients.
“It also ensures that every part of the system is as productive as possible. Where you do not have partners committed to ensuring patients are looked after in the most therapeutic setting, then patient outcomes can be compromised.”
Berenice Groves, Deputy CEO and COO Chesterfield Royal, said: “We need to push ourselves to have a consistent approach tracking of patients, throughout their journey. Right from the moment a patient enters a hospital, we need to begin the process of planning discharge – including transport and care.”
CHS Healthcare says that the survey findings demonstrate the current discharge planning model is broken and cannot be fixed without close collaboration between hospitals, social care, families, and private providers. To alleviate pressures across the system, it calls for the adoption of closer integrated system design and innovative care delivery models.
For more information on these issues and the steps that must be taken to improve patient flow, visit https://chshealthcare.co.uk/the-key-to-unlocking-patient-flow/