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Discharge planning: whose responsibility?

This week's news headlines have made my blood boil! Reports state that elderly, vulnerable patients are being discharged in the middle of the night between the hours of 11pm and 6am and the Head of the NHS, Bruce Keogh says he will investigate these finding which must cease!

Well I don't think we need Head of the NHS to tell us that this practice is not acceptable. Is this is a frequent occurrence in the present climate of a target-driven NHS: bed closures, low staffing levels and lack of collaboration between the multi disciplinary team?

As always this type of headline will neglect to report the good practice examples of discharge planning, where patients are sent home safely and with good planning and communication between health and social care providers.

However, one has to question why it has become acceptable to discharge patients in the middle of the night and why frontline staff are not standing up for patients and challenging managers who promote this practice. Surely discharge planning is a fundamental aspect of holistic care which should start the minute a patient arrives (or before, if being admitted electively)!

I can recall many situations where I have had heated discussions about whether or not it was appropriate to send a patient home with medical staff who deemed a patient” medically fit” but had not considered the many other factors which need to be considered when discharging a patient. There can be challenges as we know and equally patient's discharges can be delayed due to any number of reasons such as waiting for transport, medicines, referrals etc.

The Care Quality Commission (CQC) standards for hospitals state: “you will be involved in discussions about your care, treatment and support”. And yet we see stories about patients who have been discharged without any discussion, either with them or their relatives and let's not forget many of these patients will not have relatives or friends living nearby who can take over their care. The DOH (2010) Essence of care benchmark for planning, implementation, evaluation and revision of care states people's care should be planned, implemented, continuously evaluated and revised to meet their safety needs and preferences. Somehow, it seems from these reports that this is not happening.

The DOH (2004) suggests that “simple discharges” account for 80% of discharges from hospital, meaning 20% are more complex and require intensive health and social care provision. Whilst it is absolutely right that these patients should not be kept in hospital unnecessarily, it is equally right that they should not be discharged without a full and comprehensive discharge plan.

Sending patients home in the middle of the night or at any time without this is unacceptable and means that patients are being put at risk. Staff in primary and community care are often the ones left to deal with the consequences of poor discharge planning which can also be distressing for the patients and their relatives/ carers.

Effective discharge is about much more than bed management and should be about putting the patient first. The DOH (2004) has provided a toolkit for the multi disciplinary team which encourages “timely” discharge from hospital. Why not use NIP Forum to share examples of good practice and ways you have tried to ensure effective communication and a team approach to discharge planning?


DOH (2010) Essence of Care. London

DOH (2004) Achieving Timely “Simple” Discharge From Hospital. London

What are your views on discharge planning? Share your comments below.