Gain understanding of the NHS hospital discharge policy and how to handle it best
Discharge from hospital can be a much anticipated moment, but some people may feel anxious as hospital discharge approaches.
Who will look after me once I leave hospital? What if I struggle to prepare meals, do my shopping or take medication on time?
It’s completely natural to feel a bit worried about how life will be once you’ve been discharged from hospital. Knowing that the right type of care package awaits you once you leave hospital can help alleviate these concerns.
If you’re ready to compare care homes and evaluate domiciliary providers, we can help. But if you’re still navigating the NHS hospital discharge policy, read on.
What is the NHS hospital discharge policy?
Each hospital has its own discharge policy. You should be able to get a copy from the ward manager or the hospital's Patient Advice and Liaison Service in England and Wales (PALS), Patient Advice and Support Services in Scotland (PASS) or the The Patient and Client Council in Northern Ireland (PCC).
As early as possible after admission to hospital, the treatment plan, including details for discharge or transfer, should be developed and discussed with the individual.
A discharge assessment will determine whether more care is needed after the hospital stay. The person or appropriate representative should be fully involved in the assessment process.
Hospital staff should contact social services or there may be a social worker within the hospital or other relevant multidisciplinary team member (eg OT) to arrange a discharge assessment. It doesn't matter if your hospital stay was planned or an emergency.
The assessment should happen in the hospital, or they might visit your home to assess the environment there.
Speak to staff in charge of your discharge to make sure you have everything you need. This includes a date, care plan and equipment.
Discharge to assess
The process known as ‘discharge to assess’ recognises people have different needs once they no longer need care in an acute hospital. Staying longer than necessary is not good for recovery or wellbeing. Staff are asked to arrange discharge on the day the doctor agrees you no longer need hospital care. You cannot stay in hospital if you choose not to accept the care offered to you.
This process identifies three types of patients. Those who:
- need minimal help on discharge
- would benefit from short term support to recover further, either at home or a residential setting, before assessing their long-term care needs
- are unlikely to benefit from short term support and need ongoing nursing care, most probably in a nursing home.
If you need help putting your views across, an independent advocate may be able to help.
Temporary care/Immediate or reablement care
This is fully funded temporary care that can be put in place by the NHS or social services. It is usually no more than 6 weeks.
Intermediate NHS funded care or LA funded reablement care is the most common type, it is put in place by the NHS or LA after a hospital discharge. It is to support the client to live as independently as possible. The carers will help with activities of daily life such as personal care and meal preparation. It can build up confidence and prevent hospital readmission. Often there can be an ongoing need for care after the 6 weeks is over so it is important to contact social services to get a care needs assessment done.
Discharging older patients from hospital: Do you qualify for NHS Continuing Healthcare?
Do you qualify for NHS Continuing Healthcare which is available in England, Wales and Northern Ireland? This NHS funding can be used to pay for ongoing full-time care, if care is required for a primary health need. Older patients discharging from hospital should be assessed for NHS Continuing Healthcare before being discharged from hospital. NHS Continuing Healthcare can be provided at home or in a care home, for example.
To see whether you qualify for NHS Continuing Healthcare, a healthcare team will assess the:
- help you require
- complexity of your needs
- intensity or severity of your needs
- extent to which your needs may be unpredictable, and any potential effects on your health
A key worker, such as a hospital nurse, will manage the discharge process.
Can you refuse to be discharged from hospital?
The courts have ruled that you cannot refuse to be discharged from hospital. In 2004 and 2015, hospital patients contested NHS advice that their care needs could be managed outside a hospital setting. On both occasions, English courts sided with the NHS and ordered the patients to pay costs and vacate their rooms.
If you sense reluctance about leaving hospital, have a chat with your friend or relative to understand the reasons that may be fuelling this reluctance. Listen carefully. Repeat what your relative has said, to ensure you’ve captured each concern. Reassure your relative that his or her perspectives and thoughts are valid.
Once you understand your relative’s priorities, it’s time to evaluate and compare care options. When possible, suggest a range of options that could provide flexible care to support your relative’s lifestyle preferences.
Can care be provided at home? If care needs are more complex, would live-in care allow your relative to remain at home? Overnight care may be a complementary option worth exploring.
In ideal circumstances, the person requiring care gets to pick his or her preferred care package. But what if care package choices are limited? Or what if your relative remains opposed to receiving care? Try to remain patient, continue to listen and offer comfort.
Ultimately, safety and wellbeing must keep their place as priorities on the care journey. And unfortunately, it’s not always possible for you to be the main person who ensures the safety and wellbeing of your relative on a day-to-day basis. If you are struggling to reach an agreement about the best care package to support your relative’s needs, seek advice on how to broach the subject of care.