Ambitions for hospital discharge

During the height of the pandemic in March, an important hospital discharge guidance document was published. It allowed – through a mix of permissions, dedicated money and regulatory easements – for every health and care system to immediately introduce the discharge to assess model.

The impact of this change has been described to me in various ways; “exactly the push our system needed”, “a game changer in how we collaborated together”, ” the best permission we have ever been given”. What is patently clear, is that across the country health and social care leaders and professionals have used the guidance as an opportunity to improve how they support older people to be discharged from acute care, with greater collaboration between the NHS and other local services.

However, this positivity hasn’t been true everywhere, and there is still much to do to get this right for every patient, wherever they live.

Therefore, I am pleased that new discharge guidance is now available (Hospital discharge service: policy and operating model), and the Government has backed health and social care partners with £588 million to maintain the discharge to asses approach until the end of the financial year. This guidance and funding will allow all systems to fully embed the discharge to assess approach, maximising the numbers who leave hospital to go to their own home, rather than a care home, and support ever increasing numbers of people to rehabilitate and recover, leaving them living independently at the end of the process – the end goal that everyone shares.

These are noble ambitions, but we do owe it to our local residents to be striving for the very best outcomes for them. Equally, we should be aiming high in what we want to achieve in our local health and social care services. Why should we not aim for at least 80 per cent of older people, who no longer need the support of an acute care environment, to be discharged home on the same day with all the relevant support organised? Why are any older people transferring straight from an acute ward to a permanent residential care home placement, rather than going home first and making any life changing decisions from their own home environment in a timely way? Why can’t 100 per cent of people have their long-term care assessments and eligibility decisions made with a joint health and social care approach, within six weeks of them leaving hospital?

We know that all of this is possible because it already happens in different parts of England; our plan has to be to make them the norm in all areas of the country.

The reintroduction of NHS Continuing Healthcare assessments/reviews and the implementation of the hospital discharge guidance will in their own right put pressure on local systems. However, we must focus on improving our approach to discharge, recover and rehabilitation as we go through this implementation process. I am delighted that Karen Howell, Chief Executive of Wirral Community Health and Care NHS Foundation Trust will be joining NHS England and NHS Improvement on secondment to lead this work full time. We very much look forward to working with all local health and social care systems and organisations to implement the guidance, learn from each other and create world class discharge and recovery services in all parts of England.

Matthew Winn

Matthew Winn is the NHS England and Improvement Director of Community Health and Senior Responsible Officer (SRO) for the implementation of the Ageing Well programme in the NHS Long Term Plan.

He is also the Chief Executive of Cambridgeshire Community Services NHS Trust and has led the organisation since 2007.

Previously he worked in London in roles in Acute Care, local government and Primary Care Trusts.