Safety fears over plan to help tackle Hartlepool’s 116% rise in delayed hospital discharges

Discharge to Assess aims to speed up the release process for patients who do not need to be in hospital.
Discharge to Assess aims to speed up the release process for patients who do not need to be in hospital.

Concerns have been raised over new NHS plans to release patients from hospital before long-term care assessments have been carried out in a move to free up beds.

Hartlepool patients experienced an annual 116% increase in extra days in hospital sending between April and June at 1,302 days.

Councillor Stephen Thomas

Councillor Stephen Thomas

A practice called Discharge to Assess is due to come into effect nationally from next March to help reduce the problem of bed blocking, which reached a record high nationally in August.

Patients who no longer need acute hospital care will be provided with short-term support to be able to be released.

Longer term assessments of their care and support needs would take place later.

But care chiefs within Hartlepool Borough Council, and other local authorities, have a number of worries, including extra pressure being put on other parts of the system such as social care, care homes and district nurses, and possible risk to patient safety.

There is also a risk that some of those discharges from hospital are less safe because people are being discharged sooner than they would have been prior to this being implemented

Jill Harrison, Hartlepool Borough Council

Jill Harrison, Hartlepool’s assistant director of adult services, said: “We need to be very clear what the contingency arrangements are.

“We do have concerns that there is a risk that Discharge to Assess could increase readmissions to hospital.

“There is also a risk that some of those discharges from hospital are less safe because people are being discharged sooner than they would have been prior to this being implemented.”

The issue will be monitored by Hartlepool’s Health and Wellbeing Board.

Chair of the Adult Services Committee, Councillor Stephen Thomas, said: “To be leaving that assessment to after discharge has all sorts of risks entailed within it.

“I think there does really need to be some very close monitoring about how this turns out.”

Hartlepool and Stockton-on-Tees Clinical Commissioning Group (CCG) says the approach is based on the knowledge that people recover better in their own home.

A spokesman said: “The aim of introducing ‘Discharge to Assess’ nationally is to reduce the time people spend in hospital, at the point that they no longer need acute care.

“This needs to be done in a safe and co-ordinated way. This brings a number of benefits for the patient and the family but also improves the flow of patients through hospital.

“We recognise where patients are medically fit for discharge there is no further gain or benefit for patients to stay in a hospital bed.  Where patients require on-going assessment, planning and or provision of care needs, these needs can be met in another setting and interventions and care can be carried out closer to or at home where appropriate. 

“There is an established steering group, set up by the CCG and multiple stakeholders (including primary care, acute and community services, local authorities, mental health services and Healthwatch) that look’s specifically at delayed transfers. It looks at why patients are being delayed and what can be done about it.

“The steering group ensures a ‘whole systems’ approach and is responsible for the review of current pathways, identifying enhanced models and determining impact/risks across organisations.

“This work was underway when the national direction with regards to ‘Discharge to Assess’ was released.

“The aim of all partners is to deliver this in a way that truly benefits patients, and there is a real sense of partnership working to ensure plans are not detrimental to the delivery of care to patients across both health and social care.”