Recommendation 239

Hospital discharge procedures

Accepted
The care offered by a hospital should not end merely because the patient has surrendered a bed – it should never be acceptable for patients to be discharged in the middle of the night, still less so at any time without absolute assurance that a patient in need of care will receive it on arrival at the planned destination. Discharge areas in hospital need to be properly staffed and provide continued care to the patient.

Discharging patients where it is unsafe, because there is no care and support in place, is clearly a matter of clinical negligence and a breach of the duty of care that professionals have towards those they care for. The Department of Health can see few situations where it would be reasonable to discharge a patient at night, unless it was both safe and the express wish of the patient.

The current guidance Ready to Go sets out clear steps for local authorities and the NHS to work together to plan the safe and timely discharge of patients from hospital, or transfer of patients to another care setting. Strong multi-disciplinary discharge teams are vital to ensuring that patients are discharged in a safe and timely manner.

The government is committed to ensuring safe and timely discharges, and reducing unnecessary delays. We are supporting safe and timely discharges through spending £1bn between 2010 and 2015 on reablement services which help people to regain their independence and confidence following discharge from hospital. In 2015/16 the £3.8bn Integration Transformation Fund will bring health and social care commissioners together to plan services around people to improve outcomes and experiences.

In its initial response to the inquiry, Patients First and Foremost, the government committed to draw up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with the Care Quality Commission.

In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care. This document started the public discussion on what the fundamental standards of care should be. DH has issued draft regulations for consultation, which set these fundamental standards of care in legislation as outcomes that must be avoided, as well as streamlining and improving the clarity of requirements which must be positively achieved in order for a provider to register with the Care Quality Commission. The Care Quality Commission, through its Chief Inspector of Hospitals, is engaging with providers, professionals and the public on what guidance it should publish on complying with these regulations and how they should relate to the Care Quality Commission’s broader assessments of the quality of hospital services. The new regulations setting out fundamental standards of care, and the Care Quality Commission’s associated guidance for providers on them, will come into effect during 2014, subject to parliamentary approval.

Care Quality Commission inspectors will spend more time listening to patients, service users and the staff who care for them. They will also speak directly to senior managers and board members. Inspection will include a closer examination of records, and inspection visits at night and at weekends. The chief inspector and his inspectorate are committed to complete openness about where good and bad care is being delivered.

Update

New Fundamental Standards regulations come into force for all providers of health and social care in April 2015. The new fundamental standards are:

  • care and treatment must be appropriate and reflect service users’ needs and preferences.
  • service users must be treated with dignity and respect.
  • care and treatment must only be provided with consent.
  • care and treatment must be provided in a safe way.
  • service users must be protected from abuse and improper treatment.
  • service users’ nutritional and hydration needs must be met.
  • all premises and equipment used must be clean, secure, suitable and used properly.
  • complaints must be appropriately investigated and appropriate action taken in response
  • systems and processes must be established to ensure compliance with the fundamental standards (good governance).
  • sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed.
  • persons employed must be of good character, have the necessary qualifications, skills and experience, and be able to perform the work for which they are employed.
  • a health service body must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users in carrying on a regulated activity (Duty of Candour).

Between April and June 2014, the Care Quality Commission consulted on how it planned to change the way it regulates, inspects and rate care services. The resulting changes will come into effect in April 2015 and consultation handbooks were issued for the seven types of provider: acute,mental health and community hospitals; NHS GP and out of hours services; residential, community and hospice adult social care services. The handbooks set out for each type of provider:

  • what the Care Quality Commission look at on an inspection.
  • how the Care Quality Commission judge what ‘good’ care looks like.
  • how the Care Quality Commission rate care services to help people judge and choose care if they want to.
  • how the Care Quality Commission use information to help decide when and where to inspect.