Concern Over Hospital Trust Plan for Early Discharge

Peter Russell

January 15, 2020

Doctors condemned as "repugnant" a memo sent to some hospital staff in Cornwall suggesting that they consider discharging patients early to ease pressure on the NHS.

The email, first reported in The Guardian, reportedly described any risk as "proportionate" despite the possibility that some patients could be readmitted or come to harm.

It was sent to senior clinicians at Royal Cornwall Hospital Trusts (RCHT) on 8th January, and said the county’s only A&E department in Truro, also called Treliske hospital, had "been under significant pressure for the last 2 weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards".

The memo said it had agreed a plan to relieve pressure with unnamed "health and social care partners" after considering "a number of possible mitigations".

It added: "One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.

"It was agreed however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm," the memo reportedly said.

Hospital Pressures

The British Medical Association (BMA) described the situation as "a dire indictment of the state our NHS", and promised to back any doctor who refused to jeopardise patient care.

Before the New Year, the Trust said it was experiencing pressure on its emergency services and redirected patients with minor injuries and aliments to alternative services.

Susan Bracefield, RCHT’s director of operations, said: "It will mean we can free up nurses and doctors to support those with serious and life-threatening emergencies and with speeding up discharge arrangements for patients who are ready to go home or to other care settings.

"It's vital that we maintain a safe service for everyone and there are a lot of people who come to us who can easily be seen and treated elsewhere."

Dr Chaand Nagpaul, BMA council chair, commented: "The BMA has repeatedly warned that the NHS has been woefully underfunded for over a decade, and this has resulted in an understaffed service with inadequate numbers of beds and facilities.

"Just last week we heard that December marked another record low for NHS performance – with 1 in 5 patients waiting longer than 4 hours in A&E, and 12,000 waiting more than 12 hours for a bed.

"In the face of these pressures, this example highlights the frankly unacceptable situation doctors are facing on the ground, being pressured to discharge patients earlier than is clinically appropriate – putting both themselves and patients at risk – due to a lack of capacity and unprecedented demand."

The Doctors' Association UK said it had coordinated a letter from 2000 doctors warning that without urgent change, the NHS would be heading into its worst ever winter crisis.

Dr Rinesh Parmar, an intensive care doctor, and the Association's chair, said: "Doctors and other frontline staff have been speaking for months about how patients are coming to harm due to the crisis in the NHS.

"This crisis has not emerged overnight but on this government's watch over the last decade.

"Now comes the revelation that an NHS Trust is asking doctors to take risks and discharge patients early, knowing that this may cause harm.

"This is morally repugnant and against the very fibre of what doctors stand for. We care for our patients and respect their dignity, not simply dispatching them early into the community to already over stretched struggling services."

Long Term Plan

The Government said it was determined to enshrine in law an extra £33.9 billion every year by 2024.

Matt Hancock, Secretary of State for Health and Social Care, introduced to Parliament today the NHS Long Term Plan Funding Bill.

The Bill would include a so-called 'double-lock' commitment that placed a legal duty on both the Secretary of State and the Treasury to uphold this minimum level of NHS revenue funding over the next 4 years.

A spokesperson for the Royal College of Physicians said: "The Government’s focus on the NHS is welcome, with the 5-year funding settlement providing stability for the system. But it's clear that significant challenges lie ahead, so the figures in the bill should be seen as a minimum. 

"We know it will not be possible to both stabilise and transform the NHS with this level of funding.

"There remains an urgent need for dedicated investment in the NHS workforce. That must include training more doctors, nurses and other clinicians.

"Those working in the NHS are also acutely aware of the fragility of the social care system. 

"We urge the government to quickly place social care on a more sustainable footing."

In TV and radio interviews earlier today Mr Hancock admitted that current A&E waiting time targets are likely to be scrapped. 

BMA Emergency Medicine Lead Dr Simon Walsh said: "Ultimately, replacing targets does not address the fundamental issues of capacity and resourcing within the NHS and the resulting pressure that has led to such poor performance in emergency departments in recent years. The emergency care system is at breaking point and this, above all else, must be addressed."


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