High impact change model: managing transfers of care

This change model, developed by the Local Government Association with the Association of Directors of Adult Social Services, outlines a practical approach to managing patient flow and hospital discharge. It identifies eight system changes that will have the greatest impact on reducing delayed discharge. The resource supplements the model by bringing together examples of work being undertaken across the country, for each of the eight system changes.

Families should feel supported when their child is born preterm, says NICE

Children born preterm should be offered developmental check-ups to help identify any problems or disorders early on, NICE has said in its latest draft quality standard. 

The draft standard aims to improve the follow-up care that is provided to families from when they start planning the discharge of their preterm child from hospital.

Leaving hospital: briefing on discharge from mental health inpatient services

This briefing summarises results from a survey of peoples’ experiences of leaving mental health hospitals. Click here to read further.

Hampshire Hospitals reduce delayed discharges

Hampshire Hospitals NHS Foundation Trust shares the processes it put in place to speed up discharges, and how their measures have been successfully implemented.

Surgeons asked to staff hospital front doors to head off emergency pressures this winter

The leaders of the Royal College of Surgeons (RCS) have written to surgeons in England, encouraging them to provide support at hospital front doors (e.g. rapid outpatient clinics and A&E) over the coming months as the NHS faces arguably its toughest winter in modern times. The surgeons have also called on government to make further funding available to the NHS in next week’s Budget.

The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.

Red2Green: making a difference to our patients

A helfpul video from NHS Improvement for other trusts looking for ways to reduce delayed discharges. It explains the processes put in place across Hampshire Hospitals NHS Foundation Trust to speed up discharges and how they have been successfully implemented.

The main focus is Red2Green, but it also talks about the reasons why these measures have been brought in, with particular reference to the fact that 10 days in bed equates to 10 years worth of muscle wastage in patients over the age of 80.

Preparing for winter

The Preparing for winter guidance from the Royal College of Physicians covers the delivery of care, patient flow, wellbeing of the workforce and minimising unnecessary hospital occupancy.

NIHR Signal Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care

Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care.


This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low.


The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.


From NIHR Dissemination Centre

Flow in providers of community health services: good practice guidance

Good patient flow across health and social care systems is crucial for the NHS to run an effective and sustainable service. If patient flow is poor hospitals become congested, clinical outcomes are poorer, financial performance deteriorates and staff will be overstretched.

Delayed discharges from non-acute providers have risen as much as in acute providers over the last two years, and we recognise how important it is that we focus on the interface between community services, and other health and social care services.

Rehab Matters - film

Rehab Matters, is a short film, commissioned by the CSP, and made by Oscar-shortlisted UK director Chris Jones, looking at the difference community rehabilitation makes to the life of a woman who has just left hospital following a stroke.

Exclusive: Airbnb style company bids to place NHS patients in spare rooms

NHS pilots Airbnb style company that sources rooms in private homes for patients post-discharge

Company says “hosts” need no care experience and can help both NHS and patients

Campaigners and ADASS raise safeguarding concerns about “abuse of vulnerable people”

Members of the public with no care experience are being offered up to £1,000 a month to rent spare rooms to patients after they are discharged from hospital, under an Airbnb style model to be piloted by the NHS.


to obtain this article please contact: libraryw@uhcw.nhs.uk

Reviewing ‘stranded’ patients in hospital – what are patients waiting for?

These resources will help NHS Organisations undertake a stranded patient review in any setting, from the acute trust to reablement services. These should be multi-agency in approach. The result should support the patient along their journey, providing data and evidence to inform system change discussions.

People share their experiences of being discharged from hospital

In What happens when people leave hospital and other care settings?, Healthwatch share what over 2,000 people told local Healthwatch about their experiences of being discharged.

Back pain pilot slashed number of onward referrals

A pilot primary care service in Hertfordshire has managed to discharge 80 per cent of people with low back pain after their first appointment.

Three advanced practice physiotherapists (APPs) delivered the 12-month pilot at the Fairbrook Medical Centre in Borehamwood. It received £75,000 from the Health Foundation to improve patient experience and save money.

Other outcomes from the pilot, which ended in August, included a reduction in waiting times for spinal injections from an average of 31 weeks to just nine weeks.

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Int J Chron Obstruct Pulmon Dis. 2016 Jun 2;11:1161-9. doi: 10.2147/COPD.S91253. eCollection 2016.

Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.

SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.

UHCW Research: C. Gelder, V. Johnson-Warrington

Mental health patients stranded in units for years

Mental health patients across the UK are spending years stranded in acute units awaiting discharge, figures show.

Over the past two years, at least 91 patients have waited more than a year to be discharged, with at least seven patients waiting more than two years.

At least 320 patients had to wait at least 100 days to be discharged, BBC Freedom of Information requests show.

Experts say a lack of suitable accommodation and wrangling over budgets are to blame for the delays.

Developing trusted assessment schemes: ‘essential elements’

Through the use of a trusted assessor, we can reduce the numbers and waiting times of people awaiting discharge from hospital and help them to move from hospital back home or to another setting speedily, effectively and safely.

This guide from NHS Improvement describes how local systems could implement trusted assessment. It is for each local system, including all parties involved in a trusted assessor scheme, to agree how that scheme will operate and be funded and implemented.

Reducing delays for people moving from hospital to social care

In a written ministerial statement Health Secretary Jeremy Hunt announced (on 3 July 2017) measures to support the NHS and local government in reducing delays for people being discharged from hospital to local social care services.

The measures include:

• local authorities agreeing with local NHS organisations on the contribution they will make to reducing the number of delayed transfers of care in their local areas
• a performance dashboard showing how health and social care partners in every local authority area in England are performing against a number of metrics, including: delayed transfers of care, emergency admissions, length of stay in hospital, the number of people still at home 90 days after being discharged from hospital
• the Integration and Better Care Fund Planning Requirements 2017 to 2019, which set out how the Better Care Fund Planning process will operate

A critical care unit has introduced band 4 physiotherapy associate practitioners to provide seven-day enhanced mobilisation to elective surgical post-operative patients

The associate posts were introduced as part of a pilot service improvement project at Newcastle upon Tyne Hospitals NHS Trust, but now have ongoing funding.

During the pilot, which started in April 2016, patients showed improvement in functional mobility scores at discharge from critical care. The Modified Rivermead Mobility Index showed an improvement from 19 to 26.

There was also a reduction in length of stay and a significant increase in critical care activity in this elective surgical patient group during the pilot phase, from 326 admissions to 363.

The band 4 practitioners, Zoe Gray and Laurie Zebik, were pivotal in the success of the service improvement project and were finalists at the chief allied health professions officer’s awards in London on 21 June.

Acting without delay: How the independent sector is working with the NHS to reduce delayed discharge

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.