The challenges around hospital discharge and patient flow across the public and private are well documented. Emerging guidance and initiatives set out by the Government and NHS England suggest that immediate tangible actions are required and it is extremely encouraging to see this national effort to drive improvement.
NHS COO Sir David Sloman set out the ambition of the challenge* in a letter to staff. An NHS taskforce, aiming to improve the outcomes for patients who no longer meet the criteria to reside, has identified 10 best practice initiatives that demonstrably improve flow and therefore, should be implemented in every trust and system:
- Identify patients needing complex discharge support early
- Ensure multidisciplinary engagement in early discharge plan
- Set expected date of discharge (EDD), and discharge within 48 hours of admission
- Ensuring consistency of process, personnel and documentation in ward rounds
- Apply seven-day working to enable discharge of patients during weekends
- Treat delayed discharge as a potential harm event
- Streamline operation of transfer of care hubs
- Develop demand/capacity modelling for local and community systems
- Manage workforce capacity in community and social care settings to better match predicted patterns in demand for care and any surges
- Revise intermediate care strategies to optimise recovery and rehabilitation*
The 100-Day challenge calls for trusts to adopt these initiatives, with the aim of driving tangible improvements across systems.
Discharge Integration Frontrunner Sites:
NHS England has called for expressions of interest to become Discharge Integration Frontrunner Sites*. Aimed at local systems who are keen to lead the way in developing and testing radical new approaches to discharge, these sites will focus on overcoming issues and improving discharge from hospital.
While still in development, NHS England expects Frontrunner sites will:
- Design and test new service models, such as the delivery of a more integrated model for intermediate care across existing health and social care portfolios.
- Design and test new enabling arrangements, which might include new funding models, more integrated workforce models, or the deployment of new technologies
We look forward to hearing more about these sites in the coming weeks.
Both initiatives point to an acceptance that the current system is broken. For the challenges to be addressed, a new operating model is needed which involves active collaboration of public and private services.
Our experience of working collaboratively with the system has shown success in tackling patient flow and hospital discharge challenges. CHS Healthcare already follow best practice initiatives to ensure patients are discharged from hospital to more appropriate settings for care in a timely manner, to optimise patient outcomes. We proactively coordinate all aspects of the patient’s journey, acting as a single point of access for families, system partners and providers while being careful to set expectations and continuously keeping patients and NOK’s updated throughout the process, minimising potential family delays.
We can identify the challenges and support the system to tackle them. A new operating model based on collaborative working and a whole system approach means that hospital discharge and patient flow no longer need to be the battleground of the NHS.