News

Hospital Discharge

September 10, 2015

Patient and family choice in delayed hospital discharges: addressing the factor you can change

By Dr Richard Newland, CHS Healthcare chief executive

It is recognised that a myriad of medical, individual and organisational factors produce delays in hospital discharge. The problem is precisely recorded. Statistics released in the NHS Monthly Situation Report tell us, for example, that in July 2015, there were 4,881 patients delayed in an acute care bed. This amounts to 147,005 delayed bed days, representing the total figure for acute care being provided beyond the stage when it is clinically needed, in a single month.

The report drills down further into reasons for these delays. NHS delays are the most common cause of delays, where patients are waiting for further non-acute NHS care such as rehabilitation services or an intermediate bed. This accounts for 17 per cent of the total delays. The second largest factor is waiting for an assessment, producing 11 per cent of delays. Patient or family choice produces the third highest numbers of discharge delays, at 9 per cent of the total. This is not an insignificant proportion – choice was responsible for 11,911 delayed bed days across England in July 2015 alone.

What is the scenario behind a delayed discharge due to patient or family choice? This is something we repeatedly see and discuss with our NHS partners. When patients need to choose a care home in order to leave hospital, ward staff often do not have time to do more than provide a directory listing hundreds of care homes. Many patients and families, understandably, find this overwhelming. Choosing a care home for a parent or relative is commonly a difficult, emotional challenge and left without support and guidance, families will flounder and delay. Family choice can be particularly challenging if next of kin live far from the elderly relative, if there is a lack of transport to view homes and disputes between family members can occur, causing complex delays.

Self-funding patients are a growing proportion of home of choice patients; across the south-east, accounting for more than 70 per cent of patients who need to choose a care home in order to leave hospital. Without the support which comes with social services funding for long term care, self-funders are widely recognised as being at a high risk of delayed discharge.
Our work is founded on the recognition that when patients and families need to choose a care home, this should be a supported process. Left to do this alone, people frequently feel daunted and poorly equipped. Our advisers have the experience and local knowledge to help families focus on the care homes most appropriate for them, supporting them through visits and each step. In this way, they are making an informed, supported choice.

We regularly carry out evaluations with the families we have worked with and ask – how would you have managed to choose a care home without our service? The most common answer is: we would have got there in the end, but it would have far more challenging, stressful and would have taken a lot more time.

From a health and social care systems perspective, there is a simple message: some of the causes of delays to discharge are not easily addressed or changed. Organisational factors such as patients transferring to other parts of the NHS or assessments taking place are critical challenges to address, but may take time as they involve a complex health and social care system.

On the other hand, patient and family choice as a significant cause of delays is something that can be quickly and effectively addressed. Our dedicated, personalised support for families choosing a care home is proven to reduce delayed bed days by at least 50 per cent and equally, to enhance the experience for service users.