View from the street: Concern over hospital discharge policy

David Winskill is concerned about the impact the NHS accelerated discharge system will have on the vulnerable.

David Winskill was 'astounded' on his first trip into the City for 16 months - Credit: Archant

The pressures facing the NHS as we lurch towards winter are extraordinary.

An exhausted workforce is facing the start of the flu season and, along with frightening increases in the Covid-19 infection rate, there will be many more hospital admissions.

The backlog of electives and diagnostics/imaging is enormous and the capacity to tackle waiting lists is hampered by the imperative to avoid hospital-transmissions and rocketing staff-absences due to Covid-19 (a failure of the “World Class” Test and Track system).

NHS central is imposing fines on hospitals that fail to achieve 90 per cent of their pre-Covid-19 activity: NHS Providers has described the process as “…mad, wrong and unfair.”

Understandable there is a lot of deck-clearing going on.

In August NHS England published a new “operating model” for discharges. In a nutshell, when a consultant reckons that a patient has failed the “clinical criteria to reside “, they will be given a few hours to leave the premises.

For most, this will mean pick-up by a relieved family and a few days nestled on the sofa with the remote, lots of tea and much pampering.

Most Read

But, for the usual suspects (the old and frail, those with underlying conditions, the poor and people with mental health challenges) accelerated discharge will mean relying on their Adult Services department to ensure they are fed and watered, take medication properly, are kept warm and clean and all the other things needed to stop them being blue-lighted back to A&E.

Clearly, the new discharge model is attempting to increase the flow of patients through hospitals: it appears brutal but will succeed. However, the capacity of local authorities to cope with more and significantly sicker people is questionable.

Hancock has tossed £588m into the pot to help councils cope but, after a decade of austerity and a weakened network of community health facilities, no one is pretending that this is enough.

Speaking anonymously to R5’s Emma Barnet, a community health nurse said that she and colleagues were more worried than ever about the pressures they are under to discharge and to “discharge safely”.

I think we should be too.