National Institute for Health and Clinical Excellence (NICE)
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NICE guidance addresses the need for safe and appropriate discharge from hospital

Two reports have raised alarming concerns about the way patients are discharged from hospital.

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Delays of discharging older patients have increased, costing the NHS £820 million a year, with some patients being sent home under inappropriate and unsafe circumstances.

NICE’s social care guidance, ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’ aims to address these concerns and gaps in care.

The guidance says patients should be discharged from hospital at the right time, to the right place and in the right way – whether that is to their own home or a community or care home setting.

new report published on Thursday by the National Audit Office (NAO) estimates that 2.7 million bed days are lost due to the delayed transfer of older patients no longer needing hospital care.

The NAO estimates that increasing social care services for older patients after hospital discharge could cost around £180 million a year. But this would reduce the potential savings of £820 million that would arise from discharging patients earlier.

 Sir Amyas Morse, comptroller and auditor general of NAO, said: “The number of delayed transfers has been increasing at an alarming rate but does not capture the true extent of older people who should not be in hospital.

“While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there.”

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Whilst we understand the pressures facing our health and social care system, our guidance aims to improve the situation that some older patients are finding themselves in.

“Moving people to more appropriate community or care home settings will ensure that a patient’s wellbeing is being looked after – particularly if they are older and more vulnerable – as well as help reduce the cost burden on the NHS for hospital bed days.”

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Professor Gillian Leng

 NICE recommends offering older patients early supported discharge – this is where a patient can be discharged from hospital early to receive rehabilitation support at home. Another recommendation is that one health and care professional, either from the hospital or community-based team, should be made responsible for a patient’s discharge from hospital.

An earlier report by the Parliamentary and Health Service Ombudsman found that some patients were being unsafely discharged from hospital.

Case studies highlighted that patients were being discharged before they were well enough to go home, without a home care plan and without informing their family and carers.

Prof Gillian Leng said: “It’s more important than ever to ensure person-centred care when someone is admitted to hospital, with health and social care practitioners’ co-ordinating with each other from the time that the patient is admitted, and even before that if possible.

“We recognise that uptake of our guidance needs to improve, so we are working together with leaders in health and social care to ensure that cases like those highlighted in this report don’t happen again.”

NICE are currently producing a quality standard on the transition guidance for adults with social care needs that will highlight ways to ensure patients, their families and carers are able to cope when they are discharged from hospital.

 

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