Improving hospital discharge resources

There is a large quantity of advice, good practice, guidance and support available on improving hospital discharges. The Hospital discharge service policy and operating model (August 2020) details the discharge requirements for all NHS trusts, community interest companies, private care providers of acute, community beds and community health services and social care staff in England. The guidance, based on successful discharge to assess principles, aims to ensure that all individuals are discharged from hospital in a safe, appropriate and timely way.
Below you can find further links and signposting to some of the additional national resources, including system case studies which offer learning from the experience of others.

National reports and reviews

In 2019, People first, manage what matters was published. It examines the journeys taken by people through 14 health and social care systems across the country, with an aim of helping these systems to improve patient flow, reduce the numbers of delayed transfers of care and identify appropriate practical action to address these challenges. This work was a follow up to the Why not home? Why not today? report, with both having been designed to help inform thinking and decision-making. They cover practical examples of what works and how to overcome common challenges.

The British Red Cross report, Home to the unknown: getting hospital discharge right (2019), focuses on patients’ experience of discharge from hospital and their transition from hospital to home. The report sets out their key findings and recommendations for health and social care.

In 2018, the Care Quality Commission (CQC) published the Beyond barriers report, focused on older people’s experience of health and social care in England. Key areas of the report included a review of the support provided to people when they leave hospital, and several recommendations for improvements that could be made.

Good practice and guidance

The Hospital discharge service policy and operating model (updated 2021) details the discharge requirements for all NHS trusts, community interest companies, private care providers of acute, community beds and community health services and social care staff in England.

A set of role-based hospital discharge action cards are also available, which summarise responsibilities for key roles within the hospital discharge process. Patient leaflets can be downloaded to support conversations around discharge with patients, families and carers (available in translated versions and Easy Read).

A series of quick guides can support local health and social care systems by providing practical tips, case studies and links to useful documents, which can be used to implement solutions to common issues.

The High impact change model for managing transfers of care was updated in 2020 to include learning from the COVID-19 pandemic. It outlines nine key changes that systems could focus on to improve hospital discharge.

The Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) produced a short top tips guide to safe, timely and appropriate discharge from hospital. It provides a short list of questions systems should be asking themselves to ensure they are putting individuals first by promoting a Home First and discharge to assess approach. Also available are the Top tips for implementing a collaborative commissioning approach to Home First.

National Institute for Health and Care Excellence (NICE) guidance is available to help support the transition between inpatient hospital settings and community or care home settings for adults with social care needs.

Training

The Home First, Act Now eLearning Programme increases awareness around Home First principles in the discharge policy. The programme supports health and care professionals involved in the discharge process to act in a way that values patient time and helps facilitate safe and timely discharge. It is relevant for a range of health and care professionals including nurses, allied health professionals, care staff and students across NHS providers, commissioners and social care.

Teams and organisations working to support hospital discharge

The Better Care Fund
The Better Care Fund (BCF) programme supports local systems to successfully deliver the integration of health and social care in a way that supports person-centred care, sustainability and better outcomes for people and carers. Conditions outlined in the BCF planning requirements ensure local partners have an agreed approach to support safe and timely discharge. This approach should include ongoing arrangements to embed a home first approach. Plans should also set out how BCF funding (including any voluntarily pooled funding) aligns in support of discharge. Bespoke support is available for systems which would like help to develop their BCF plans, implement discharge to assess, have been experiencing challenges or wish to accelerate their BCF and integration ambitions. Support is also available to implement local system’s winter plans. They have a number of support options available including peer-led workshops, enquiries and bespoke support as well as case studies and good practice.

Emergency care improvement support
The Emergency Care Improvement Support team (ECIST) is a clinically led programme that offers intensive practical help and support to urgent and emergency care systems across England leading to safer, faster and better care for patients. The team provide implementation support to systems embedding discharge to assess.

NHS Continuing Healthcare
NHS Continuing Health Care (CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. In order to receive NHS CHC funding, individuals have to be assessed by clinical commissioning groups (CCGs) according to a legally prescribed decision-making process to determine whether the individual has a primary health need.

Reducing length of stay
The Reducing in Hospital Length of Stay (RiHLoS) programme provides patients with a better care experience by ensuring they are discharged from hospital without unnecessary delay. Reducing unnecessary long length of stays will lead to better patient experience and outcomes as well as increase capacity and flow  within the system.

Elective and emergency care
The Elective and Emergency Care (EEC) directorate provides national guidance and support to drive continuous improvement in elective and urgent and emergency care services across the NHS.