NHS Plans to Reduce Long Hospital Stays

Peter Russell

August 21, 2019

An effort to help tens of thousands more people avoid lengthy spells in hospital in England has received a broad welcome.

However, one expert told us that the success of the campaign would largely depend on healthcare professionals having access to appropriate care packages to ensure safe discharge.

Doctors, nurses, and other staff were encouraged to ask themselves 'Why not home? Why not today?' when planning care for patients recovering from an operation or illness under an NHS England plan called 'Where Best Next?'

The aim of the plan is to prevent around 140,000 patients a year staying in hospital for 3 weeks or more, freeing up over 7000 beds for other patients.

NHS Long Term Plan

The campaign involves placing posters and other information in hospitals aimed at nurses, doctors, and other staff, encouraging them to take practical steps to help get patients closer to a safe discharge – whether to their own home or in the community.

The campaign is in line with ambitions set out in the NHS Long Term Plan, NHS England said.

Prof Stephen Powis, NHS medical director, said: "I know how hard frontline NHS staff and their council colleagues have worked over the last year to reduce delays in discharging patients, but we want to ensure that all patients benefit from the shortest possible stay on a ward, getting home as soon as they are fit to leave with the support they need.

"Not only is that better for them, reducing the risk of infection or loss of mobility for older people in particular, but it also means that more beds are available for others who need care too, easing pressure on A&E and other parts of the system."

Almost 350,000 patients currently spend more than 3 weeks in acute hospitals each year.

Many of those are older people who are often frail, and NHS England said that while a short period of treatment in hospital was sometimes necessary, staying too long could leave them vulnerable to infections or deconditioning.

Five Principles

The campaign, developed in partnership with Royal Colleges, the Local Government Association, and patient groups including Age UK, would focus on five principles for ward staff when they were planning care. These were:

  • Planning for discharge from the point someone was admitted

  • Involving patients and their families in discharge decisions

  • Identifying frail patients as soon as possible and making a specific plan for their care

  • Having weekly multi-disciplinary team reviews for all long stay patients

  • Encouraging a 'home first' approach, including assessing people at home where possible

Campaign Could 'Butt Up Against Reality'

Dr Ian Higginson, consultant emergency physician, and registrar of the Royal College of Emergency Medicine, said there was no question that 'bed-blocking' was one of the causes of a lack of hospital capacity. However, a campaign designed to make people think about discharge could "butt up against reality" because of inadequacies in the system.

He told Medscape News UK: "There's undoubtedly an element that healthcare professionals are reluctant to discharge patients until they're absolutely sure that what they're doing is safe. But I don't think that's in any way an indictment of those healthcare professionals, because it's all of our responsibility to make sure that patients we discharge are discharged to a safe environment, in the right state."

Dr Higginson said that when it came to discharging patients, "unless there are the right facilities to look after patients, and the right resources in place in the community to ensure that patients are adequately monitored, then that will mean that patients aren't sent home as soon as they might be".

He added: "There's no question for those of us on the frontline that patients are getting older, they have more complex medical problems, including cognitive dysfunction, and they have more vulnerable community networks."

NHS England insisted that progress to reduce lengthy hospital stays was being made. In 2018-19, the number of hospital spells longer than 3 weeks was reduced by almost 1 in 10 compared to the previous year, it said.

Also, although separate figures on delayed transfers of care showed that in June an average of 4500 people each day were experiencing such a delay, that was down almost a quarter from the same month 2 years ago.

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