Hospital Discharge

Investing in social care to improve hospital discharge.

The UK government has recently announced an additional £600 million for social care. While the detail of this funding is to be revealed, additional investment in care services could present a significant opportunity to improve hospital discharge. But it is important that this funding is used carefully to maximise the impact it can have.

A timely intervention

The additional funding comes at a crucial moment. New research by national learning disability charity HFT and healthcare provider body Care England revealed that 40% of adult social care providers were in deficit in 2023. The report also shows that 43% of providers had been forced to close services or hand back contracts. A further 18% of providers were offering care to fewer people and 39% had considered exiting the market altogether. Within this context, new funds become even more important.

Supporting Workforce Development

A significant portion of the funding should be allocated to workforce development. This includes recruiting more care workers, providing them with better training, and ensuring fair pay. Recent research from The Health Foundation showed that nearly one in ten (9.9%) of adult social care roles in England was vacant – leaving major gaps in service provision. A well-supported and trained workforce is crucial for delivering high-quality care. It is also crucial to the management of patient transitions from hospital to home or care.

Preventing Hospital Readmissions

Better care in the community, supported by this funding, can significantly reduce the rate of hospital readmissions. This is especially important when you consider that many individuals who leave the hospital return due to a lack of suitable care. By ensuring that patients receive adequate support after discharge, the risk of complications and health deterioration can be minimised.

Integrated Transfer of Care Hubs

Investing in making Integrated Transfer of Care Hubs work should be a priority. These hubs aim to enable the seamless collaboration between healthcare and social care professionals and organisations. This funding can facilitate the development of these hubs, ensuring that patients experience a coordinated and smooth transition from hospital care to social care.

Leveraging Technology in Social Care

A portion of the funds should be dedicated to integrating technology into social care. This could include the adoption of telehealth services, remote patient monitoring, and digital health records. In our recent survey of social care staff, 54% felt that admin and paperwork was a significant driver of delayed discharge. Tech also has a key role to play by automating processes and reducing this burden.

The announcement of additional funding is always welcome. If used effectively, this funding has the potential to improve hospital discharge processes and overall patient care. It is imperative that this funding is strategically allocated to areas that will provide the maximum benefit, fostering a more efficient, integrated, and patient-centric healthcare system.

What is the impact of delayed discharge on A&E targets?

The link between discharge and admission:

Historically the winter is the hardest season for the NHS. With higher incidents of seasonal illnesses and vulnerable people more likely to be hospitalised, meeting increasing demand is a significant challenge for the NHS.

With more people trying to access hospital care, efficient discharge of patients who are ready to leave is vital. Unfortunately, this can be a challenge, with latest figures showing around 12,000 people a day are ready to be discharged but left waiting to leave. For many systems, hospital discharge can come to a complete standstill over winter.

The link between the ‘back door’ of hospital discharge and the ‘front door’ of the hospital, is highlighted by a recent report from the Health Foundation:

“Patients who stay in hospital when they are ready to be discharged are at higher risk of hospital-acquired infections and of losing mobility and independence. Delays in discharging patients also impact on the availability of hospital beds, leading to delays in ambulance handovers and in admitting patients from A&E.”

Operational targets:

To address winter pressures, the government has again set out a plan to deliver operational resilience across the NHS. This plan aims to contribute towards two key ambitions related to recovering Urgent and Emergency care:

  • 76% of patients being admitted, transferred, or discharged within four hours by March 2024
  • Improving ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24

Category 2 ambulance calls are those that are classed as an emergency or a potentially serious condition that may require rapid assessment, urgent on-scene intervention and/or urgent transport. All ambulance trusts should respond to Category 2 calls in 18 minutes on average and respond to 90% of Category 2 calls in 40 minutes.

The operational standard set for Emergency departments in 2010 stated that at least 95% of patients attending A&E should be admitted, transferred, or discharged within four hours. In December 2022, an intermediary threshold target of 76% was introduced with further improvement expected in 2024/25.

Current trajectory:

To understand if these targets will be hit, CHS Healthcare has analysed the last 18 months of NHS data. Though there has been a slight increase in the percentage of attendances in 4 hours or less, the trend of 2023 to 2024 closely follows that of 2022 to 2023.

Based on the current trajectory, by December 2023 only 66% of A&E attendances will be admitted, transferred, or discharged within four hours or less. Furthermore, by March 2024, only 72% of A&E attendances will be in four hours or less thus falling short of the 76% target set by the NHS.

This is particularly alarming as the Royal College of Emergency Medicine argues that performance below 75% is the point at which patient safety risk becomes seriously elevated. This is due to patients having to wait for long periods of time in overcrowded and uncomfortable A&E department waiting rooms leading to conditions worsening significantly before treatment can be given.

Data has also revealed that an estimated total of 23,003 excess deaths in 2022 were associated with long wait times in the Emergency Department, meaning there was an extra death for every 72 patients who spent eight to twelve hours in A&E. Dr Adrian Boyle, President of the Royal College of Emergency Medicine, stated:

“We must see a renewed focus on the four-hour access standard. We believe the new four-hour target of 76% is unambitious and is too low, it presents the risk that the sickest and most vulnerable patients will continue to face the longest waits.”

Despite the 76% target being considered unambitious, according to the current trajectory, this target won’t be reached if last year’s trend is followed. With A&E times worsening, it is expected ambulance response times will follow.

In 2022 to 2023, the average ambulance response time for category 2 incidents was 49:54. If trends from last year continue, it is projected that ambulance response times will be 36:36 for 2023-2024, still falling short of the average 30-minute target. With category 2 calls responding to people who need urgent care such as suffering from a heart attack or stroke, there are severe consequences associated with ambulance delays.

Working together this winter:

It is clear that significant operational challenges are on the horizon. Hospital discharge impacts heavily on the whole system, including A&E and ambulance handovers. With winter almost here, outcome-focused action is urgently needed, and improving patient flow offers a route to improvement. We must invest in bespoke initiatives to ensure every aspect of the system is getting the support they need.

CHS Healthcare brings over 25 years’ experience in improving patient flow through outcome-focused commitments to you and your patients. We are ready to mobilise, offering you flexible ways to partner with us, and helping to operate your integrated discharge system.

We have designed a range of services – underpinned by knowledge and understanding of what works – and we will work with you on an outcome-focused basis. From free and pay-as-you-go services to longer-term partnerships, working together we guarantee to improve your average hospital discharge performance by 5 days or less.

Our team has accumulated the tools, knowledge, and expertise to improve patient flow. Through our proven delivery solutions, since 2020 we have successfully supported more than 50,000 people to be safely discharged and transferred patients into the right care they need.


Get in touch to talk to us about our flexible and easy to implement solutions.

Contact Lucy Chapman for further information.




A&E waiting times | Nuffield Trust

One in four A&E wards is unsafe, say doctors (

Data show 1.65 million patients in England faced 12-hour waits from time of arrival in A&Es in 2022 | RCEM

Winter pressures checklist: 12 things hospitals can do to prepare for winter and beyond

Our recent analysis of NHS data found that the number of patients stranded in hospitals across England on Christmas day despite being medically optimised could rise to 14,178, a 54% increase on the 9,200 patients who remained in hospital last Christmas. As we head towards the middle of an intensely pressured winter, we’ve created a 12-step checklist to ensure all bases are covered when managing pressures this winter and beyond.

1. Collaborate across teams

The current hospital discharge model is based on multiple different teams all performing specific tasks. We must improve how these teams work and plan together, ensuring increased continuity of care through case management, breaking down silos between disjointed teams and ensuring families and carers are informed every step of the way. Poor communication between teams has been shown to increase discharge delays so this approach can help reduce discharge delays for medically optimised patients.

2. Extra resources

Many UK hospitals are operating at full capacity and hardworking staff are working flat out to deliver the care that their patients need. With the existing discharge operating model so complicated and burdensome, staff barely have a spare minute to spend on the admin processes required for discharging patients. The resource cannot be found inside an already stretched workforce. The NHS should consider collaboration with the private sector who can provide extra resource and capacity, meaning that hospital staff will have more time to be there at the bedside with patients.

3. Reduce admin

54% of care home staff and managers and 49% of hospital staff responding to our recent survey reported that one of the top factors contributing to delays in discharge is paperwork, admin and bureaucracy. With staff resource and capacity in extremely short supply and paperwork can easily fall by the wayside and add additional pressures. Processes can be made more efficient to reduce the admin burden on staff, freeing up more time to focus on getting well patients out of hospital.

4. Engage with families

Families and next of kin should be involved at every step through admission to discharge. In our survey, 92% of hospital staff agreed that engaging with the patient’s family and carers early on makes for a successful discharge. However, this does not always occur, meaning that the discharge process is delayed by conversations with families that should have started at an earlier stage.

5. Digital oversight

Many hospitals still rely on paper-based patient records. Records can be easily lost and it takes additional time and effort to find and send the relevant papers, further slowing down the discharge process. This ultimately results in staff loosing valuable time to otherwise avoidable or repetitive tasks. Technology and data can unlock flow, allowing safe automation and accurate prediction of when patients will be medically optimised.

6. Embracing new technology

The advent of new virtual ward and remote monitoring technologies enables patients who would otherwise occupy a hospital bed to be monitored and supervised safely at home. For many patients, this approach is far preferable. They can receive the same care and treatment in a familiar environment close to family and loved ones and avoid the anxiety of not knowing when they will be discharged. Numerous case studies and pilots are revealing the success of virtual wards and remote monitoring, and effective usage of this technology can help to tackle the bed occupancy crisis.

7. Digital prediction tools

What if hospitals could predict the exact day that a patient may be ready for discharge? This approach would dramatically enhance patient flow by allowing discharge plans to be put in motion ahead of the day the patient becomes medically optimised. For example, families could get their relatives home environment ready, or care homes could have a place reserved, rather than a frantic rush on the day to get the patient out as soon as possible. By collaborating with innovative private providers, hospital and care home staff can utilise such technology to transform patient flow.

8. Case management

In the current hospital discharge operating model, patients are passed along the chain with insufficient focus on case management from point of admission to discharge. This type of system can be detrimental to patient care, as crucial information can be lost in the chain, impacting hardworking professionals who are required to double check and second guess to ensure patients’ needs are being met. Effective case management from admission to the hospital back door is critical to improving patient flow. When patients receive joined up care throughout the entire discharge pathway, planning can be done in the most efficient way possible.

9. Planning from the start

NHS guidance states that discharge planning should start at admission – but our survey showed that in 31% of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised. With all the barriers to effective discharge in place, it’s easy to see how patients can spend weeks longer in hospital than they need to due to ineffective planning. Due to the complexity of the discharge process things don’t always go to plan. There might be difficulties contacting the patient’s next of kin, care homes in the area might be full, the hospital could have lost important paperwork. These factors can add further delays so it is important to have capacity in the workforce to deal with issues when they arise.

10. More use of Discharge to Assess

Our survey also revealed that 2 in 5 hospital workers (40%) are unaware of the government’s ‘Discharge to Assess, Home First’ policy. This guidance is designed to avoid delays in care discharge by providing short-term care and reablement in people’s homes or by using ‘step-down’ beds to bridge the gap between hospital and home. We welcome further consideration of D2A as a longer-term solution to tackling current NHS pressures, but to succeed, the scheme requires a collaborative approach across the NHS, social care, private providers and the voluntary sector.

11. Understanding the local community

Understanding needs of the community is important for early care planning. Currently hospitals have a reactive model in place – reacting to patient’s needs when they present in A&E or emergency departments. But what if we could look further ahead of this and anticipate potential care needs in the community before they lead to hospitalisation? Developing our understanding of population health in our local communities can help to anticipate acute concerns, and understanding people’s broader social and living situations can help put plans in motion for discharge before they are admitted in the first place.

12. Planning for the future

The pressures faced by the NHS in recent years have been like nothing on record. There are valuable lessons to be learnt from how crises have been managed that we can apply going forward. With efficient discharge and patient flow processes in place, hospitals won’t bear the brunt of external pressures as much as they would if they were already at full capacity. Decision makers can look to examples of innovation and effective partnerships between the NHS, social care, voluntary sector and private sector where discharge processes have been successfully transformed, and continue to apply these going forward.

By redesigning the hospital discharge system, NHS services can reduce pressure on staff and improve access to and quality of patient care.

Contact us to find out more about how CHS Healthcare can help you this winter:


Our response to NHS England’s new plans to alleviate winter pressures

NHS England has announced new plans to set-up system control centres or ‘war rooms’ as they prepare for one of the toughest winters yet. These ‘war rooms’, which will be employed with the goal improving patient flow and hospital capacity across the UK, will implement a digital approach to tracking beds and attendances. The plans also include increase bed capacity by bringing back ‘mothballed’ beds. 

Whilst CHS Healthcare welcome NHS England’s plans, these plans represent a very tactical approach. To tackle delayed discharge, we need to truly understand the root causes, otherwise new beds will be quickly filled with patients waiting to be discharged.

Working with hospital and care home staff, and NHS leaders, it is clear that the reasons for delays are multifaceted, including siloed working between teams and a disconnect between health and social care. In order to deliver the change patients and services need, we need to re-engineer discharge processes and improve collaboration across the system ensuring that all relevant parties are involved in discharge planning at the earliest stage.

We also need to put additional emphasis on case managing patients through the system, so that they receive joined up care, and that discharge plans are made in the most efficient way possible. We must also make sure we are actively engaging with families and next of kin throughout the entire process, to ensure that a patients’ needs and wants are involved in the planning for discharge.

The current discharge planning model is broken. To alleviate winter pressures and create systems fit for the future, we must not rely on tactical measures and find ways to foster the close collaboration between hospitals, social care, families, and private providers to ensure smooth discharge processes.

CHS Healthcare welcome new government plans

Today, new Health and Social Care Secretary Thérèse Coffey announced the government’s plan for coping with winter pressures, titled ‘Our Plan for Patients’.

Key to the plan is a £500m social care discharge fund which can be used flexibly by local health and care systems to help people who need further support out of hospitals and into social care. At CHS Healthcare we welcome this funding announcement, but the devil will be in the detail. We look forward to finding out more about how this will be rolled out.

Also key to the plan is a call on the general public to participate in a national endeavour to support the health and social care system. One of the key collaborators in effective discharge is family members and next of kin, so we support this drive to increase family engagement with health and social care services. Our recent survey showed that involving families earlier in the discharge process can lead to more effective discharge and reduce delays. 92% of staff agreed that engaging with the patient’s family and carers early on makes a successful discharge. If we can increase this engagement as part of a national drive to get the general public more involved with help, it could have significant benefit.

Patient flow is the art of integrated care in action

Sebastian Stewart, Service Development Director, CHS Healthcare

It seems every day there is another report released which looks at the patient flow challenge plaguing the NHS, riddling our hospitals and seeping into social care. Each of these reports looks at patient flow from a different angle and diagnoses a new treatment.

Most recently the Royal College of Emergency Medicine made a plea for an additional 13,000 beds noting that 25,000 beds have been lost in the last decade. Reported in the Guardian their view is that these ‘staffed beds’ would “meaningful change and improvement”, which includes a “significant” improvement in A&E waiting times, ambulance response times, ambulance handover delays and a return to safe bed occupancy levels. It recommends opening at least 4,500 of these before winter.

At the same time the government’s programme to build new hospitals has been back in the news due to lack of progress. The hold up being blamed on a lack of funds to push ahead with building.

As we move into a new phase for the NHS, noted for its focus on integrated care, it feels old fashioned to look to beds and hospitals as the solution for our aging and increasingly dependent population. At the end of April according to NHS data there were 12,580 patients who no longer met the criteria to reside waiting in hospital to be discharged. This resonates with the 13,000 beds requested in the report above, but the issue here is complicated – not a lack of beds or staff but a seemingly intransigent issue where people are unable to move from an acute bed to a bed fit for their care needs.

Bed blocking, delayed transfers of care, stranded patients and super stranded patients, no longer meeting criteria to reside, pyjama paralysis – there are so many labels for the challenge of people moving from hospital. The HSJ reported last week that NHS Confed viewed that it was ‘impossible’ to improve delayed discharge at this point. This is a very pessimistic picture which is likely to get worse this winter before it gets better. And of course, this has patients and families at the centre of every delay.  We can’t forget how damaging additional beds days can be for older peoples physical and mental wellbeing.

It can often seem that the NHS is stuck between short term fixes, often driven by unreliable funding, and long-term solutions that are tantalisingly out of reach.

New funding, new buildings and new staff are all unlikely to transpire in the near future so we have to look at how we can create space and flow within existing parameters.  The potential impact integrated care can have for hospital discharge is a nirvana which I hope acts as a clear measure for their success. We stand ready to support with the design and implementation of new pathways and innovative care solutions.

In the meantime, our view is that there is a middle ground which involves a focus on driving connections and creating permanent new work-flows within the existing parameters. We work with over 60 trusts in England and we see the challenges faced by staff day in and day out.  We know that dedicated discharge support for patients as soon as they are admitted drives flow. We know that removing the burden of discharge coordination from clinical teams will create space and flow, we know that there is untapped flow sitting with the trusted assessor model. There are initiatives that can be put in place now to make a difference but they have to be embedded as standard, not just temporary fixes, which as soon as they stop let delays build back up.

Helping people out of hospital into care is often underestimated. It sounds like it should be easy but it is the art of integrated care in action. It connects clinical teams with care homes, with families, with rehabilitation, with pharmacists, with primary care and all of this happens at pace and while each piece of the puzzle is moving. For too long hospital discharge has been a problem to be solved as a reaction to difficulties as opposed to a driver for change in how we design and deliver care.

A reflection on “Winter pressures: Is care coordination the key to capacity this winter?”

Uko Umotong, National Discharge and Community Services Manager, CHS Healthcare

On 15 October, we discussed solutions to the most significant challenges to maintaining elective capacity this winter in our webinar ‘Winter pressures: is care coordination the key to capacity this winter?

We were joined by Jane Taylor, Deputy Director Urgent Care, NHS Northamptonshire Clinical Commissioning Group as well as Richard Parker, Board Member of North Norfolk Primary Care, and experienced senior NHS Operations Director as we addressed the crucial decisions those in the health and care system should make while planning ahead for this upcoming winter.
The NHS has had a hugely challenging few months, and as we turn to autumn and winter, the pressure across the entire sector is clear to see. The main obstacles we identified in maintaining elective capacity is recruitment and staffing vacancies, community capacity and an ever-increasing demand at A&E.

How can health and social care professionals enable flow across services?

An integrated approach – why care coordination is vital:

Winter plans – as we once understood them – are no longer fit for purpose with Covid, flu and the backlog we need to have a close look at the alternatives and additions including how to maximise community services. We don’t need to look too far to see the integrated approach some clinical teams and other groups took during the pandemic last year which are strong and positive examples of what professionals can do this winter by working together.

Jane Taylor said: ‘There is no simple solution unless we start coming together. Alignment, connectivity and joint working is absolutely essential during this period. We saw it during Covid, we took down barriers, we had conversation that we thought we’d never have and we need to remember what we did through that and drive it’.

‘At the acute front door, I have a primary care stream, I have a separate out of hours that runs out of there overnight and the key element here is – how do we work together? We always look ahead to where we want to be and where we can start to drive things now rather than wait for the formalities.’

Communication as a catalyst for effective coordination

Although a coordinated and integrated response from the health and social care sector is vital to maximising services, setting expectations and closely guiding patients and their families is an important factor to ensure overall efficiency.

Richard believes ensuring ‘much tighter and tidier communication with patients and families about how they are, what to expect and how to better navigate the system’ is the best approach to encourage patients to still seek treatment without having to increase capacity.

For Jane, communication is also a way to make sure hospital re-admissions are reduced. ‘I certainly have a managed pathway that I use for non-weight bearers which is managed from the point of view of discharge through fracture clinics and out the other end and having a team that manages flow and works to make sure those patients stay out of hospital is something I think we can apply if we’re making sure to follow up with them – it all comes down to communication and making sure who is doing what’.

Can extra funding and the new operating guidance enable smart capacity?

Although the operating guidance is a useful tool to overcome the challenges ahead, it doesn’t have the same degree of impact for private providers including care homes. The focus here is how we can utilise existing resources in a productive way instead of relying on funding.

As the 7 days 8am–8pm working and other initiatives are put in place, Richard believes that they add little value to the system and are harder to implement in practice in the light of the current workforce challenges.

‘What we saw during Covid in the Norfolk health system was that the clinical team actually redesigned the way they worked, there’s been support by commissioners who have taken their hands off the handlebars with the conventional community contract to allow for more creativity and to be more outcomes focused and that’s really worked and motivated the team’ Richard said.

This highlights the many ways we can innovate services and work around looming pressures with the existing resources we have. How can we work together to re-invent the way we work this winter?

‘What gives me some hope for how we might work differently through the winter is concentrating on patient flow through a step-down care home environment – an innovation I witnessed during Covid. Working in partnership with a care home provider with support from senior nurses and a virtual GP who would oversee the discharge issues that were arising in real time led to a reduced re-admission rate and much shorter lengths of stay’ Richard said.

Care coordination – the missing link to patient flow

There is still little awareness about how the coordinated care model works and even more so how it can contribute to speedy and safe discharge. The benefits extend from the overall reduction of occupied beds to improved capacity but also allows for strong support to be provided to patients and their families.

‘Partner relationships rather than siloed working is key but the challenge we have now is breaking it down and standing up to say it’s a model we want to work with’ Jane mentioned.

Care coordination is a feasible and effective solution to current challenges although it requires a mindset favouring overall change, innovation and transformation.

CHS Healthcare has been supporting CCGs with hospital discharge pathways nationally for 25 years and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact to discuss your needs.

You can access a recording of the webinar here:

Beyond summer pressures: Maximising patient flow through dedicated care coordination

Uko Umotong


Although we are painfully familiar with ‘winter pressures’ there has been a glut of reports highlighting the pressure on the NHS this summer – summer pressures.

This weekend the Institute for Fiscal Studies said that the waiting list for elective surgery could balloon to 14 million procedures by this autumn. Currently,  there are 5m people waiting for surgery. The difference relates the millions of ‘missing patients’ who would have, in a normal year, joined the waiting list but due to the pandemic have not come forward or are not yet on the list.

Hospitals and ambulance trusts have been reporting OPEL alerts at level 3 and 4 as they struggle to cope with unplanned admissions.  It was predicted back in the early days of the pandemic many people who didn’t seek care at that time would start to present to health services through emergency pathways.  Primary care is also experiencing the impact with many struggling to cope adding further pressure on A&E. Some GP practices are reporting that they may need to close or reduce services due to concerns about their ability to provide safe care under such a volume of demand. Staff challenges are also impacting with Newcastle upon Tyne Hospitals Foundation Trust closing 10% of its beds due to staff absences.

Looking at this from a distance it all feels overwhelming and paints a particularly bleak picture for this winter. The challenge ahead – to provide care for covid, seasonal flu, as well as support the restart of electives is no small feat. The simple truth is that regularly hospitals are operating with no spare beds at all. At the centre of all of this is patient flow – making sure patients are moving into services when they need and out as soon as they can.

It was therefore a welcome intervention from NHS Providers last week who called on the government to maintain funding for discharge to ensure that it is made as easy as possible to move medically optimised patients into rehab beds in the community. The emergency funding for hospital discharge removed the artificial barriers which were slowing down discharge – as Chris Hopson notes before the pandemic it wasn’t unusual for 20-30% of beds to be occupied by patients who were ready to move on.

This funding is important, but it is not alone enough to solve the epic demand related challenge for the NHS this winter. And it’s vital to note that capacity in the community is not infinite.  Where that capacity is providing complex care, it is in very short supply indeed. Therefore managing this carefully is critical to maintain flow out of rehab beds and into long term care releasing those rehab beds back for new patients.

But what else can be done? Admission avoidance is driving some of the most innovative and integrated projects in health and care. While efficiencies are being recognised at the backdoor (and there are more to be had) there are also efficiencies at the front door which support flow. Care Coordination is about working alongside patients as soon as they present at A&E, staying in close contact with family and carers, making sure that what these patients need to head back home is sorted and implemented as speedily as possible.  In a best-case scenario this results in no bed being needed at all but otherwise it aims to avoid a community rehab bed being used when it is unnecessary. Therefore reducing cost and maintaining that bed for someone for whom it is essential.  Critical to this is providing the capacity and dedicated skills to work closely with families and patients helping them to make the decisions and choices which will allow them to move from hospital to home quickly and safely.

Getting through the next eight months will be a rough ride but there is no shortage of innovation and commitment to get care right by utilising resources carefully and implementing innovative structures. The initial phase of the pandemic was a huge learning curve and much has been made of the positive learnings to come out of that difficult time. As we look ahead past summer pressures it is possible with the right funding, partnerships, and systems in place there is every opportunity for us to come out of winter with a better understanding of patient flow and how the front and back door can work differently together.

Managing safe discharge and Covid-designated spaces this winter

Uko Umotong, Hospital Discharge & Community Services Manager

Government guidelines request that NHS and local authorities ensure a 14-day isolation period for patients discharged from hospital into the community. As has been reported recently there are a limited number of beds designated for this purpose, which is why it is important that existing capacity is managed closely to deliver consistent and efficient patient flow. At the same time, we must provide a safe and reassuring experience for patients and their families.

We recently held our fourth session in our ongoing webinar series, “Managing safe discharge and Covid-designated spaces this winter”. Joining the webinar were guests from across NHS trusts, CCGs and local authorities. We were pleased to be joined by Natalie-Jane Macdonald, CEO, Sunrise Senior Living and Tina Snowdon, Area Manager CHS Healthcare to discuss the importance of efficient tracking and management of Covid-designated spaces under the new government guidelines this winter.


The challenge of designated settings

Speaking from her first-hand experience of seeing how Covid-designated settings were being handled and implemented, Tina noted that the process has been hindered where a “one size fits all” approach was taken, and that contextual insight is critical for each setting. 

As Covid-designated spaces are allocated, the primary blockers to efficient patient flow and correct implementation include the number of beds and space of the care provider, test results not coming back in a timely fashion, as well as simple lack of clarity regarding the next steps. People are often unsure of what is happening next and lack the necessary information required in determining whether a patient is ready to move on and where they need to be going.

Furthermore, as Natalie noted, designated settings are a good idea but for certain patients, such as someone with cognitive impairment, going to hospital in the first place is a hugely traumatic experience. To then move somewhere else – where they have likely never been – to be looked after and then to move again can cause significant deterioration in their level of functioning. “Our Sunrise or Gracewell home is our residents’ home. We have to be able to welcome them back from hospital whatever their status is,” she said. 


Tracking and oversight are critical for safe discharge

At the time of the webinar, the latest CQC data on Covid-designated settings and the South East showed that 1,500 beds had been provided by local authorities for use as designated beds, but only 141 of them were approved for use by the CQC. With a limited number of beds, we need to be able to know who is where at any given time and what their care needs are.

We are currently working well with the D2A model and designated discharge settings. “If we know where a patient is going before they leave hospital and we know that they are there for two weeks, then we can be planning while they’re in hospital, before they go to their designated discharge setting, and identify where they need to be going onwards from there. The flow has already been mapped before they leave hospital,” noted Tina. There have also been successes in using available hospital wards for the 2-week isolation period to avoid the use of an additional separate setting, though this is again subject to bed availability. 

Discharge planning should start at admission and this imperative doesn’t change because of Covid-19. “It is critical that we are using beds efficiently, ensuring tight tracking, making sure plans are in place and that everyone involved is aware of what is going on, including a patient’s family. When we pull these facets together, we can really have a slick and swift operation while ensuring as minimal impact to the patient as possible, as the patient is at the forefront of all our minds,” noted Tina.


Looking ahead

When asked about the current state of play, both Natalie and Tina agreed that it is essential to recognise that everyone is experiencing the same level of uncertainty, noting that each person and every organisation has a role to play in supporting care at this time. While it is critical to reduce and prevent infection, organisations must be focussed also on doing their utmost to maintain quality of life for patients and their families, for the limited time they may have together.

Looking ahead, the best way forward is to ensure clear and efficient communication amongst all partners, recognising that together we are able to cope with the challenges posed by the pandemic. Placing patients’ needs at the forefront of decision-making and efficiently implementing detailed planning and tight tracking of a patient’s journey through the system is the basis of effective patient flow.

As Tina concluded, “This year we have seen the ability for people to adapt and to pull together and work together and implement things that they never believed they could do”. This is the energy we need to continue with in the year ahead.

CHS Healthcare has been supporting CCGs with hospital discharge pathways nationally for 25 years  and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact to discuss your needs.

You can access a recording of the webinar here:   

Care homes trust our hospital discharge process

By Uko Umotong

An in-depth assessment of our work in East Yorkshire shows what care homes value:

  • trust
  • quality of information
  • communication and family support

East Riding of Yorkshire Council carried out the independent evaluation in January 2019 and asked care homes about their experience of hospital discharge co-ordination provided by CHS Healthcare.

The main themes are:

  • CHS Healthcare provide quality information and regular communication to care home which can sometimes be lacking in hospitals which are a busy and demanding environment
  • Care homes highlighted the importance of trust, when hospitals and care homes have different priorities in the discharge process this can sometimes create challenges

Quality information and consistent communication supports efficient discharge:

“The CHS Healthcare standard of calls is much better than the hospitals and the social workers.  Sometimes the care home can get three separate phone calls all about the same person; the calls are much better managed where CHS Healthcare is involved.”

Care home liaison means we can reduce pressure on wards and care homes:

“The wards are so busy that hospital staff don’t have time to speak when the care home manager goes to assess; sometimes it is difficult to know who to speak to on the ward.’’

We provide accurate referrals:

“The ward can be more generic in how they describe the person; the description from CHS Healthcare is much more accurate.”

We reduce anxiety for families and patients:

“CHS Healthcare will ring the care home and agree when it is appropriate to attend and then contact the family; the family seem more at ease, and better informed; whereas before, family would visit unprepared and not knowing what to ask / look at; families coming through CHS Healthcare appear less stressed and more comfortable.” 

“Usually CHS Healthcare meet the family and takes them to the care home which works very well. Families can be apprehensive but CHS Healthcare acts like an advocate to the family. Visits are always smoother if CHS Healthcare is there.” 

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