October 6, 2016, by Charlotte Anscombe

Hospital discharge – why does it create such issues? And are there any resolutions?

A Select Committee report published last week found that the incidences of unsafe discharge from NHS hospitals is still unacceptably high.

Professor Justin Waring and Dr Simon Bishop from Nottingham University Business School, led on research, (funded by the National Institute for Health Research), which contributed towards the committee’s findings and its recommendations.

The Select Committee report found that the increasingly worrying figures were as a result of ‘political maladministration’. The inquiry was led by the Public Administration and Constitutional Affairs Committee (PACAC).

What is poor patient discharge?

Poor patient discharge can be where patients are kept in hospital longer than necessary, or where patients are discharged before it is clinically safe to do so, or without appropriate support in place.

The inquiry by the PACAC, looked at the work already carried out by the PHSO (Parliamentary and Health Service Ombudsman), which highlighted upsetting cases that showed the human costs of poor discharge.

This latest inquiry found that these cases are not isolated, and despite the ongoing attention around this worrying issue, it is still a persistent problem experienced by patients, relatives and carers.

Down to the nitty gritty – what are the main cause of these problems?

Whilst guidance on good discharge practice is available, the extent to which good practice is implemented varies across the country.

The Committee is now calling on health and care leaders to ensure staff are operating in a culture where ‘person-centered care’ is the priority.

The Chairman of the Committee, Bernard Jenkin MP said: “Hospital staff seem to feel pressured to discharge patients before it is safe to do so. Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred  care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge.”

What needs to be done?

Professor Waring previously wrote: “At their bluntest, these problems can probably be summed up in two points: The various individuals and agencies involved in hospital discharge routinely fail to communicate with each other effectively – and the issue is unlikely to be resolved any time soon, as the staff best placed to make the process work are most likely to lose their jobs in the funding cuts.

“This may sound alarming and depressing in equal measure – and it is. Not least when viewed through the prism of the public sector’s steady annihilation, it’s hard to see how things might improve in certain settings. So, is there any hope?”

Professor Waring and his team made recommendations on possible interventions and practices to support discharge planning and care transition, which contributed to the findings of the Select Committee Report.

Their study suggested a number of ways in which communication might be enhanced to improve the discharge process.

Professor Waring said: “Encouragingly, in our study we found that different interested groups agree that it’s everyone’s business – including the patient’s – to support and contribute to the discharge process. That this doesn’t happen isn’t due to a lack of willingness, it’s due to a basic absence of communication and coordination. “

So what now?

As per the findings of both the Select Committee and the results of Professor Waring’s research, hospital discharge is a complex process that requires intricate interaction between all agencies involved.

The conclusions and the recommendations of the Select Committee have been clearly set out – so only time will tell if these recommendations help.

Professor Waring adds: “A joined-up approach to modern-day healthcare is essential, in large part, because of its misperceived simplicity. What the everyday act of hospital discharge illustrates especially well is that one-dimensional notion of drawing a line in the sand and declaring ‘my work is done’ is increasingly unsustainable.

“’Our work continues’ is a much better mantra for modern-day healthcare. Whether those who hold the purse strings have any interest in pursuing this, or any other ideal though, is another matter altogether.”


To see Professor Waring’s full piece on the Conversation visit the website.

A full copy of the study carried out by Professor Waring can be found here.


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