The anticipated strain on acute beds, as a result of the Covid-19 pandemic, has meant that hospitals need to ensure beds are used only for those patients strictly in need of in-hospital clinical care. NHSE and NHSI (with input from other bodies) has produced the ‘Hospital Discharge Service Requirement’ which sets out the new discharge process Trusts must apply during the pandemic.

What is the purpose of the discharge requirement?

To ensure that patients are discharged from hospital as efficiently as possible as soon as they are fit for discharge, so that those beds can be ‘freed up’ and used for patients in need of in-hospital treatment.

Who do the discharge requirements apply to?

Discharge requirements apply to:

• NHS Trusts
• Community Interests Companies
• Private care providers of acute beds, community beds and community health services
• Social care staff in England
• Health and social care commissioners (including CCGs and Local Authorities)

When must patients be discharged? 

Unless required to be in hospital, patients must not remain in an NHS bed. Annex B sets out the strict clinical circumstances which require continued admission. If patients do not meet any of these criteria, they must be discharged as soon as it is clinically safe to do so.

How quickly must patients be discharged? 

Very quickly. Discharge from the ward to a designated discharge area should happen within 1 hour of the decision being made and discharge from hospital should happen within 2 hours.

Do hospitals need to keep track of patients ready to be discharged?

Yes. Hospitals (both acute and community) must keep a log of patients suitable for discharge and report on the number and percentage of patients on the list who have left the hospital, with the number of delayed discharges, through the daily situation report.

What about those patients who may be eligible for CHC?

NHS CHC eligibility assessments have been placed on hold during the pandemic, so that this does not delay discharge. The government has also agreed increased funding. Please see our insight on CHC commissioning for more information on this.

How can we find available beds quickly?

Most people will be discharged to their own homes, but a small proportion will need ongoing care in a short or long term residential or nursing home. The Discharge Service will be able to access live information from a national community bed tracker system. This will cover all care home places, NHS community hospital beds and hospice beds. All providers should have signed up and started using the tracker from Monday 23 March 2020.

What if a patient (either with or without capacity) refuses to be discharged? 

The usual processes apply. The hope and expectation is that vast majority of patients and families will appreciate the severe need for hospital beds and will agree with discharge, even if it is not to their preferred location. Once discharge has taken place, discussions can be had in the community about moving patients to alternative long term placements in due course if needs be.

The discharge requirements have essentially created a streamlined discharge process for acute and community hospitals. Healthcare professionals must follow these requirements as closely as possible, to ensure that limited in-hospital resources are reserved for those patients in need of in-hospital clinical treatment.

How Capsticks can help

If you have any queries around what's discussed in this article, and the impact on your  organisation, please speak to Charlotte Radcliffe or Francis Lyons to find out more about how Capsticks can help.

For urgent out-of-hours queries please contact our emergency bleep on 0208 780 4860 and you will be put in touch with a solicitor who will be able to assist you.