Hospital discharge and homecare UK

A call for urgent action from an incoming government

The Homecare Association has published a new report on hospital discharge in the UK, seen through the eyes of homecare providers and the people they support.

The report, entitled: “Expecting the Unexpected“, reveals widespread problems with hospital discharge. Despite guidance, funding and a national taskforce, many integrated care systems are not getting the basics right. This puts the safety and wellbeing of people leaving hospital at risk.

We call for urgent action from NHS leaders, commissioners and an incoming government following the general election, to ensure hospital discharge processes are safe and prioritise the wellbeing and needs of individuals, their families and the providers that support them. 

Key findings from the report include:

  • Over half (55%) of homecare providers said hospital discharge paperwork does not reflect knowledge of the person being supported, including their needs and views. 
  • A third (35%) said most hospital discharges they are involved with are not safe. Issues include lack of equipment, medication errors, and poor communication.
  • On average, homecare providers spend 4 hours per person chasing avoidable issues with discharges, such as inadequate discharge notes.
  • 63% of homecare providers said people are being discharged from hospital too soon, leading to readmission.
  • 40% of providers reported more avoidable hospital admissions than ever before.
  • Three quarters of providers said the people they support are finding it harder to access healthcare than they did this time last year.
  • More than half of providers noted it was difficult or very difficult for people they were supporting coming out of hospital to get the support they needed from other professionals: mental health (67%); social workers (64%); physiotherapists (59%); dentists (55%); occupational therapists (54%); and specialist nurses (51%). Half of providers said it was difficult or very difficult to access support from GPs (general practitioners).
  • Two-thirds (65%) said while there are discharge delays in their area, they have unused homecare capacity.
  • Homecare providers called for their inclusion in assessments and multi-disciplinary teams; outcome-based commissioning; payment of sustainable fee rates; and payment of invoices on time.

The report makes 35 recommendations for change, including:

  • NHS leaders must follow and audit existing discharge guidance, and act urgently on findings before winter 2024/25. 
  • An incoming government must provide sufficient funding to councils and the NHS to cover homecare costs. Failure to do so risks unsafe care and greater costs to the Treasury.
  • Commissioners must pay sustainable rates for homecare on time; offer greater security of hours to providers; and involve them in shaping services.
  • The Department of Health and Social Care must deliver its planned social care workforce reforms, backed by at least £8-18bn annual investment.

Commenting on the report, CEO of the Homecare Association, Dr Jane Townson OBE, said:

“This report is a shocking indictment of the state of hospital discharge in the UK. The stories we hear from our members up and down the country are scandalous.

“Homecare services can play a vital role in enabling safe, timely and effective discharge, and supporting people’s recovery at home. But all too often, we are seeing unsafe, chaotic and distressing discharge practices that are failing patients and families. This is unacceptable.

“We call on NHS leaders and commissioners to implement the recommendations in this report as a matter of urgency. We also need to see clear commitments and funding from an incoming government to fix social care and enable it to play its full role in integrated care systems. Investing in homecare is not only the right thing to do for those who draw on services, it also makes economic sense.”

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