Hospital discharge arrangements: A joint submission to the Health and Social Care Select Committee

Summary

The Health and Social Care Select Committee is currently holding an Inquiry into Delivering Core NHS and Care Services during the Pandemic and Beyond. It’s stated aim is to ‘give focus to these upcoming strategic challenges, and give those working in the NHS and care sectors an opportunity to set out what help they will need from Government in meeting them’[1].

In its call for evidence the Inquiry has specifically identified ‘meeting the needs of rapidly discharged hospital patients with a higher level of complexity’ as one of the issues it will cover [2]. This is a joint submission (see attachment) to the Inquiry by Patient Safety Learning and CECOPS which is focused on this specific issue.

Content

During the initial impact of the COVID-19 pandemic, the Government recognised that a key enabler would be to increase capacity within the NHS, ensuring that enough acute beds were available to cope with the rising tide of patients. An important policy priority has been to ensure the safe discharge of patients back into their home or, where appropriate, into a placement with a community provider. While there were already pathways in place to accelerate this process, responding to the pandemic required a significant acceleration of hospital discharges.

Hospital discharges are complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to equip the home or community setting with the appropriate equipment and care plans.

In this submission to the Inquiry, Patient Safety Learning and CECOPS focus on:

• Rapid hospital discharge - considering the challenges to this caused by the pandemic, the importance of interoperability in overcoming these, preventing care homes and nursing homes becoming vectors of transmission and harnessing digital technologies, such as an app, to assist hospital discharges.
• Community support - as the rate of hospital discharges significantly increases, the need to consider the availability of Personal Protective Equipment supplies, access to and guidance on supportive equipment and technologies and other pressures that will need to be met by community support services.

In the concluding comments the submission sets out an eight-point action plan required to tackle this issue:

1. A model of demand to inform hospital discharge and planning of community and care services
2. New agile ways of working using digital technologies. An improved cross health and social care information system is imperative to ensure safe transfers of care
3. Strengthened cross-sector leadership and communication with clinical teams and patients and families
4. The provision of equipment services addressed urgently - to support hospital discharge and prevent admissions i.e. wheelchair, prosthetic, orthotic and equipment services
5. Integration of planning and service delivery across sectors with the right leadership, the ability and capacity at a local level to streamline services and procurement to the needs of patients, families, and care providers
6. Innovation in the development of safe transfers of care. We must adapt the traditional bureaucratic processes and regulatory framework to ensure that the needs of patients are met speedily
7. Financial support to ensure that there is capacity to provide community-based care
8. The safety of patients at the core of all plans and service delivery. All plans should include how the safety of patients is being prioritised.

References

[1] UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 7 May 2020. https://committees.parliament.uk/work/277/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/

[2] UK Parliament, Call for evidence: Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 29 April 2020. https://committees.parliament.uk/call-for-evidence/131/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/