HEALTHCAR E DE LIVE RY
often claimed. In addition to social care capacity, what are the other root causes?
1 Lack of collaborative working: The current hospital discharge model is based on thirteen teams, working across primary, secondary and social care. This includes the medical staff who are responsible for the medical review of patients, developing clinical plans and deciding who is well enough for discharge; the Acute Therapy Team who assess people’s short-term recovery needs and agree a plan for support; and the Discharge Team who work with wards to discharge people.
In this system, patients are passed along the chain with insufficient focus on case management from point of admission to discharge. The challenge we hear about is that this leads to a lack of joined up care, with each team working in silo and passing on to the next person in the chain. This type of system is not only insufficient, but 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. Our survey also reveals that 2 in 5 hospital workers (40%) are unaware of the Government’s ‘Discharge to Assess, Home First’ policy.5
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. It is worrying that so many professionals are not aware of this protocol.
2 Planning is starting too late To avoid delayed discharge, Government guidance states that ‘early discharge planning from admission is required’.6
treatment nears completion or once the patient is medically optimised.
In
most cases, it is reasonable at admission to make some assumptions about the onward care a patient will or will not need, and roughly when they might be ready to leave. Of course, the path of healthcare rarely runs smoothly, but it has been proven that the earlier planning starts the better. However, our survey reveals that that in 31% of cases, hospital discharge is not discussed until
3 Avoid the admin burden NHS services rely on administration processes to ensure system-wide alignment and quality of care. Yet, staff are being burdened with lengthy and unaligned processes, which ultimately result in staff losing valuable time to otherwise avoidable tasks. We have spoken to numerous hospital workers who pull their hair out at the countless forms and handwritten notes that they have to deal with on a daily basis. With hospital teams across the UK already working at full capacity, due to immense external pressures, it is unsurprising that admin might be a significant time drag. Almost half of hospital workers taking part in our survey (49%) reported that paperwork, admin, and bureaucracy cause delays to discharge. We would support and encourage a move away from paper-based admin, instead embracing innovative digital tools to safely automate processes, to keep track of patients’ status, and even to predict when they will be ready for discharge – thus allowing efficient planning and case management.
From a survey conducted by CHS Healthcare earlier this year, of frontline NHS and social care staff, our data showed that social care challenges are complex and not simply a case of not enough space, with a clear disconnect between the perspectives of hospital and social care staff.
NOVEMBER 2022
4 Families and next of kin One of the key collaborators in effective discharge is family members and next of kin. Our conversations with healthcare leaders across the UK tell us that when families are engaged at an early stage, discharge is more efficient. Our survey showed that involving families earlier in the discharge process can lead to more effective discharge and, therefore, reduce delays. 92% of staff responding to our survey agreed that engaging with the patient’s family and carers early on makes for a successful discharge.4
If we can increase this engagement
as part of a national drive to have the general public more involved, it could have significant benefit. At the time of writing, the Health and Social Care Secretary has called for a “national endeavor” with volunteers to be recruited to support health initiatives. This should also see members of the public obligated to engage with healthcare professionals as quickly and early as possible when their loved ones are in hospital. At CHS Healthcare, we would fully support a drive to increase family engagement with health and social care services.
And what do we need to do to turn things around?
1 We need to design a new collaborative integrated operating system that incorporates the best of health, social and private providers It is clear from our work that the current discharge operating model is broken, and we cannot continue to blame a lack of capacity – whether that is in social care or on hospital wards. We urgently need to re-engineer processes and drive greater coordinated
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