• Hospitals told to discharge patients from ward within three hours
  • Eligibility and funding decisions and continuing healthcare assessments suspended
  • “The guidance effectively says: don’t worry about the rules, just do it,” says senior figure

Health and care organisations have been ordered to take radical measures to speed up discharges and help free up 15,000 beds by the end of the month.

The drastic measures include suspending all eligibility and funding decisions from the hospital discharge process and temporarily scrapping continuing healthcare assessments — a move which requires legislative changes but hospitals have been broadly told get on with anyway.

The new discharge criteria also mean patients must be discharged from hospital on a three-hour target: one hour from the ward to the discharge area and then discharged from the hospital within around two hours from then.

One senior policy expert told HSJ the guidance “basically amounted to orders which say: whatever it costs, get people out of hospital. Don’t worry about the rules, just do it.”

The person added: “Inevitably, some corners are going to cut and we may have to hold our nose a bit. But given where we are, that’s a price we’ll have to pay. 

“We aren’t going to have people discharged with fully evaluated assessments. We just don’t have the time to do that. We need front-line staff fully focused on treating patients.”

The measures, set out in guidance sent to trusts last week, are part of a £2.9bn package for the NHS and councils set out by ministers last Thursday. The money is from the government’s £5bn emergency coronavirus fund.

Several sources told HSJ they did not think ministers’ target for clearing the 15,000 hospital beds by Friday 27 March was realistic, especially with staff already facing shortages as some have been advised to self-isolate. But it was also argued the target was a useful means of stressing the level of urgency.

Trusts have been allocated £1.3bn of the total, with the rest going to councils, the vast majority of which will pay for social care. The package is part of the NHS’ overall goal of freeing up 30,000 beds ahead of the expected surge of covid-19 patients in the coming weeks.

However, significant tensions have already emerged between hospitals and care homes around patients who are ready to be discharged but have not been tested for coronavirus and also around personal protective equipment, as revealed by HSJ last week.

HSJ has been told care and nursing homes have refused to accept discharges unless the patient has been tested for the virus. Testing is not a requirement under the discharge guidance issued by the government on Thursday.

What the guidance says

On discharging from ward to community

“Based on [the new] criteria, acute and community hospitals must discharge all patients as soon as they are clinically safe to do so. Transfer from the ward should happen within one hour of that decision being made to a designated discharge area. Discharge from hospital should happen as soon after that as possible, normally within two hours.”

Continuing health care assessments ‘not required’

“The current legislation does not describe a specific timeframe for carrying out NHS CHC assessments of eligibility, or for individual requests for a review of an eligibility decision (ie. Local Resolution and Independent Review). Therefore, NHS CHC assessments for individuals on the acute hospital discharge pathway and in community settings will not be required until the end of the covid-19 emergency period. Planned legislative change, as part of the covid-19 Bill, will further support the NHS in relation to this.”

NHS to fund care packages

“The government has agreed the NHS will fully fund the cost of new or extended out of-hospital health and social care support packages, referred to in this guidance. This applies for people being discharged from hospital or [who] would otherwise be admitted into it, for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services.”

Source: COVID-19 Hospital Discharge Service Requirements guidance published by the Department of Health and Social Care