Patients left with unmet care needs under ‘discharge to assess’ model, report finds
Healthwatch England and the British Red Cross have jointly published a new report, which unveils that significant numbers of people are not receiving follow-up support or appropriate mobility equipment after being discharged from hospital under new policy.
The report – ‘590 people’s stories of leaving hospital during COVID-19’ – reviews the experiences of 590 people under the Government’s ‘discharge to assess’ model, which was introduced in March 2020.
Implemented at the peak of the COVID-19 pandemic by the UK Government, this discharge model aimed to help hospitals free up 15,000 beds and cope with demand. It was backed by £1.3 billion in NHS funding, which aimed to enhance the NHS discharge process so patients who no longer need urgent treatment can return home safely and quickly.
According to the new report, although the speed at which people were discharged from hospital was important, it also led to worse care and a lack of support for some patients leaving hospital. It further reveals that once patients have been discharged, there are frequent issues relating to the provision of mobility aids in the home and a lack of consideration of people’s home situation after they left hospital, e.g. living alone or mobility constraints.
The research exposes where the current policy is creating gaps in care and calls on the NHS to address these issues as the UK enters the traditionally busy winter period amidst growing pressures of a second COVID-19 wave.
Healthwatch England and the British Red Cross gathered the insights of over 500 patients and carers via a survey, who experienced the discharge to assess process from hospital from March to August 2020. Eight local Healthwatch and partners around the country also carried out 61 in-depth interviews with key staff groups involved in hospital discharge processes.
Findings reveal that over 82 percent of respondents did not receive a follow-up visit and assessment at home and almost 20 percent of these reported an unmet care need. In addition, other people felt their discharge was rushed, with roughly one in five saying they felt unprepared to leave hospital.
Patients and carers also report issues around receiving mobility equipment, despite the discharge to assess guidance indicating that commissioners for NHS and social care equipment were to ensure that local equipment services had enough supply and that patients leaving hospital could quickly access any equipment they needed, seven-days-a-week.
The report unveiled that only six percent of people who had an assessment discussed equipment and mobility aids, highlighting what the British Red Cross and Healthwatch England describe as a “critical gap” in the assessment of people’s needs after they leave hospital.
Furthermore, paid carers echoed this observation and suggested that there was a lack of support and consideration for people’s home situations and living conditions, including their need for mobility devices.
The report also uncovered that provision of mobility devices was not always provided in a timely manner, if at all, with carers saying they had difficulties ordering equipment for discharged patients as this was a new way of working for many services.
As well as unmet equipment needs, 35 percent of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance. However, survey respondents overall felt very positive about healthcare staff, praising their efforts during such a difficult time.
Furthermore, just under one third of respondents said they faced an issue with delayed COVID-19 test results, potentially putting family and carers at risk, or, when in a care home, other residents and staff.
Commenting on the findings, Healthwatch England Chair Sir Robert Francis QC said: “In March, hospitals were asked to discharge patients with little or no notice and the speed with which this took place was important but led to mistakes. We do not want to detract from the heroic efforts of those on the frontline, who often put themselves at great risk to care for their patients, but services and system leaders have now had more time to prepare.
“It’s essential that we learn from what people have shared with us about the impact that a poorly-handled discharge can have on them and their loved ones. Taking action now will not only reduce the risk to patients but will also help improve the way people leave hospital in the future.”
Drawing on these findings, the report makes several recommendations to help hospitals manage a second wave of COVID-19 hospital admissions ahead of winter.
It says that services should implement post-discharge check-ins and assessments to ensure people are offered follow-up support soon after discharge, whether by phone or face-to-face.
The British Red Cross and Healthwatch England also make several recommendations to improve access to equipment to support people’s recovery. They say that local health systems should address the barriers preventing quick access to equipment that community health and care staff raised in the report. These included unclear or restrictive local policies, as well as a lack of training.
In addition, the organisations suggest that local commissioners should ensure equipment services are sufficiently supplied throughout the winter period, when increased needs for equipment and assistive technology are expected. The report further advises hospitals to routinely offer information about accessing mobility aids at the point of discharge with clear contacts.
British Red Cross Chief Executive Mike Adamson commented: “As winter approaches and the pandemic continues, the British Red Cross is working alongside NHS and social care services to get people home safely from hospital. We’ve seen first-hand the huge efforts made to improve the discharge process for patients and their families.
“However, we also know despite good intentions and hard work, there are still barriers to making the ideals of discharge policy a reality.
“The Red Cross has been bearing witness to these issues for years, and we hope that the increased urgency of the situation will bring lasting change. Many of the people we support are older or more vulnerable, and fall into the higher-risk categories for Covid-19.
“Simple interventions, like getting equipment and medicine delivered, or follow-up visits, can make the difference between good recovery or someone regressing to the point of readmission – precisely at the time we want people to stay well, and stay at home.”
The report recommends the use of discharge checklists, where patients are asked about the support they need, including any transport home and equipment required. Healthwatch England and the British Red Cross also suggest that patients and carers are given a single point of contact for further support or questions, in line with national policy.
Moreover, the report says that linking patients to voluntary sector partners or community pharmacists who can deliver medicine would avoid hospital discharge delays. In addition, the organisations say that longer-term and more investment is needed in community care capacity to speed up the hospital discharge process.