Scrapping discharge fund will give the NHS a dangerous capacity squeeze

Matthew Taylor profile picture

06 August 2021

Matthew Taylor
Chief Executive
NHS Confederation


The history of public policy is littered with disappointed expectations. The NHS is facing multiple threats and social care is grappling with the lack of a sustainable funding model. So, when an initiative succeeds, and when it does so in the tricky area of health and social are integration, surely we would want to keep it? Sadly, the government seems on the verge of doing the reverse.

The issue in question here is the discharge to assess approach. This has been one of the conspicuous successes of the NHS response to the pandemic. It has enabled thousands of medically fit patients to be discharged, ensuring they are not kept in a hospital bed any longer than needed.

Before the pandemic, between 20 and 30% of NHS acute beds were consistently occupied by patients who were ready to leave hospital but were waiting for confirmation of a care package or transfer to a community or care home bed. The new approach – discharge to assess – guarantees four weeks of care support for each discharged patient, funded centrally. Patients can leave hospital as soon as they are medically ready, freeing up vital capacity. The NHS, social care and patients and their families then have a full four weeks to finalise longer term care arrangements.

Discharge to assess has worked on many levels. It's worked for the NHS, freeing up 30,000 beds during the first COVID-19 wave with a 28% reduction in patients staying more than 21 days between winter 2019/20 and winter 2020/21.

   

Discharge to assess has worked on many levels. It's worked for the NHS, freeing up 30,000 beds during the first COVID-19 wave with a 28% reduction in patients staying more than 21 days between winter 2019/20 and winter 2020/21. It's worked for social care, providing vital, stable, funding to fragile social care providers and supporting more people to live well at home. With better use of short-term recovery services, there has been reduced need for formal care and support packages. And discharge to assess has driven much greater integrated working between health and care. It's worked for the public purse as NHS England and NHS Improvement data shows discharge to assess has delivered £450m of hospital bed savings and freed up over 6,000 staff, including almost 4,000 nurses.

Above all, it's worked for patients by cutting recuperation time and avoiding the increased likelihood of physical and mental deterioration and lost independence associated with longer hospital stays. It's helped reduce the risk of hospital-acquired infections including COVID-19. It's also meant a lower level of care need post discharge as patients are usually assessed in their place of residence, better calibrating the care package to actual patient need.

At one hospital in the Midlands, average waits for patient discharge with a care package reduced from 17 weeks to less than half a day. Increased therapeutic support has meant four in five patients were discharged with no immediate support, up from just over half of patients, and the average length of hospital stay was cut by a week. In Birmingham and Solihull, the numbers of people medically ready to leave has reduced from around 650 to a much more sustainable 250-275. In Sussex, the average length of stay has fallen by 37%.

But all this is now at risk, in less than 60 days. Given the uncertainties of COVID-19, the government only set NHS budgets for the first half of the year.

   

But all this is now at risk, in less than 60 days. Given the uncertainties of COVID-19, the government only set NHS budgets for the first half of the year. And, despite repeated requests, it has refused to confirm extension of the dedicated £600m April to September discharge to assess funding for the rest of the financial year.

Frontline leaders are deeply concerned that failing to extend this funding will bring huge risk for the NHS, social care and patients. The NHS is currently under huge pressure. Growing waiting lists, record levels of urgent care demand in emergency departments and ambulance services, and the loss of around 15,000 of the NHS' normal 100,000 beds due to COVID-19 infection control are translating into very worrying, high, levels of hospital bed occupancy. These pressures will only increase as we head into the traditionally intense winter months.

Failure to extend discharge to assess into the second half of the year will give the NHS a dangerous capacity squeeze just as we come into winter when NHS bed capacity is at its tightest. Inevitably, the NHS will have to slow down care backlog recovery. Waiting times for urgent and emergency care will lengthen. Ambulance handover delays will grow. These will all, inevitably, compromise patient care. Failing to extend will also increase pressure on an already hard pressed social care system. And it would seem bizarre to axe a successful policy initiative that supports social care just as the government unveils the comprehensive social reform package it has promised in the autumn.

Timing is of the essence here. Trusts and local authorities are already having to make major decisions at risk and many are reporting that, as a result, discharge flow is starting to slow down.

   

Timing is of the essence here. Trusts and local authorities are already having to make major decisions at risk and many are reporting that, as a result, discharge flow is starting to slow down. Given the four week funding envelope it is vital that the government makes a decision on the future of discharge to assess funding by mid August. There are few positives to come out of the pandemic but speeding up the safe discharge of medically fit hospital patients has been one of them. It feels very odd having to publicly persuade the government to continue a highly successful policy it's introduced. But frontline health and care leaders are desperate not to lose the progress they've made here. The ball is now firmly in the government's court.

This blog was first published by HSJ.

About the author

Matthew Taylor profile picture

Matthew Taylor
Chief Executive

Matthew Taylor is the chief executive of the NHS Confederation and has had a distinguished career at the heart of public policy for the last 20 years. He has led the Royal Society for the encouragement of Arts, Manufactures and Commerce for 15 years and during that time he has transformed the organisation into a global institution, with 30,000 fellows and a high-profile and influential research programme.

Before that he was chief adviser on political strategy to prime minister Tony Blair, and he also ran the Institute for Public Policy Research for four years. He is a widely known commentator on policy, politics and public service reform and regularly appears on national media programmes, including as a panellist on BBC Radio 4's Moral Maze. He was also commissioned by the Conservative government in 2016 to carry out an independent review into modern employment practices. Matthew started his career as a health policy researcher in the West Midlands.