There is a large quantity of advice, good practice, guidance and support available to health and social care, housing, and voluntary sector organisations on improving hospital discharges. This section provides grouped links and signposting to some of the national resources and local case studies that may be helpful, offering learnings from the experience of others.
National reports and reviews
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.
In 2018, a review entitled ‘People First, Manage What Matters’ was commissioned to examine the journeys taken by people through 14 health and social care systems across the country. The aim was to help these systems to improve patient flow, reduce the numbers of delayed transfers of care, and to identify appropriate practical action to address these challenges. This work is a follow up to the ‘Why Not Home? Why Not Today?’ report.
These reports are designed to help inform thinking and decision-making. They cover practical examples of what works and how to overcome common challenges.
Good practice and guidance
There is a suite of eleven quick guides providing information, case studies and guidance on a range of topics relating to health and social care integration.
The High Impact Change Model for Managing Transfers of Care was refreshed in 2019 to include input from a range of partners. It outlines nine key changes that systems could focus on to improve hospital discharge. The model is endorsed by Government through its inclusion in the Integration and Better Care Fund (BCF) policy guidance.
The ‘Where Best Next?’ campaign provides key principles and resources to support NHS organisations reduce long hospital stays.
Teams and organisations working to support improved hospital discharge
The Reducing Length of Stay (RLoS) programme aims to provide patients with a better care experience by ensuring they are discharged from hospital without unnecessary delay.
As a key part of the NHS Long Term Plan, the Ageing Well programme supports older people managing long-term conditions, making sure they receive the right support to help them live as well as possible.
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.
The Emergency Care Intensive Support Team (ECIST) is a clinically led programme that offers intensive practical help and support to 40 urgent and emergency care systems across England leading to safer, faster and better care for patients.
Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.
NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
The Better Care Fund (BCF) is a programme spanning both the NHS and local government which seeks to join-up health and care services, so that people can manage their own health and wellbeing and live independently in their communities for as long as possible.
Homelessness and Duty to Refer
People experiencing homelessness and rough sleeping:
- experience much poorer health than the general population; mortality rates are eight to twelve-fold higher than the general population
- use acute hospital services four times, and access A&E seven times, more than the general population. They are more likely to be admitted to hospital as emergencies, which costs four times more than planned elective stays.
The Homelessness Reduction Act 2017 ‘Duty to Refer’ requires social service authorities (adult and children’s), emergency departments, urgent treatment centres and hospitals (providing inpatient care) to refer services users who they think might be homeless or threatened with homelessness to local authority homelessness or housing options teams.
Additional guidance for NHS staff has been published to support NHS organisations to implement arrangements to meet this requirement.
NHS England requires hospitals to send inpatient and day case eDischarge summaries to GP practices electronically. As of 1st October 2015, discharge summaries are no longer allowed to be sent by post or fax.
If you need support to develop eDischarge summaries, the Royal College of Physicians Informatics Service has a new learning resource which is published on the Professional Records Standards Body website.