New NHS plan to help patients avoid long hospital stays

Action to help tens of thousands more people avoid lengthy spells in hospital is being rolled out nationwide as part of the NHS Long Term Plan.

NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of a campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more.

As well as being better for those individuals who get home with the right support quicker, the drive could also free up more than 7,000 beds for other patients – the equivalent of building an extra 15 large hospitals.

The campaign, launched today, will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community.

NHS medical director, Professor Stephen Powis, said: “I know how hard frontline NHS staff and their council colleagues have worked hard over the last year to reduce delays in discharging patients, but we want to ensure that all patients benefit from the shortest possible stay on a ward, getting home as soon as they are fit to leave with the support they need.

“Not only is that better for them, reducing the risk of infection or loss of mobility for older people in particular, but it also means that more beds are available for others who need care too, easing pressure on A&E and other parts of the system.”

Nearly 350,000 patients currently spend over three weeks in acute hospitals each year.

Many of those are older people who are often frail, and while a short period of treatment in hospital is sometimes necessary, staying too long can leave them vulnerable to infections or deconditioning.

Research suggests that more than one in three 70-year-olds experience muscle ageing during a prolonged stay in hospital, rising to two thirds of those aged over 90, which can leave some permanently less mobile or able to perform tasks they could before.

Caroline Abrahams, charity director at Age UK, said: “Reducing the length of stay in hospital is crucial to an older person’s well-being and ultimately helps them regain their independence more quickly when they return home.

“That’s why it’s very important that older people are able to leave hospital as soon as they are medically fit. A swift discharge is only possible by having a discharge plan in place on admission which is shared across organisations. Most importantly, there must be joined up services to fully support people at home when they are discharged to keep them well and avoid readmission.”

Progress is already underway; in 2018/19 the number of hospital spells longer than three weeks was reduced by almost one in ten compared to the previous year.

As well as meaning that patients could recover in the more comfortable and familiar surroundings of home, this also freed up the equivalent of almost 1,800 hospital beds for use by other people who needed urgent treatment or to recover from a planned operation.

Separate figures on delayed transfers of care, which measure the number of extra days someone spends in hospital after they have been declared medically fit to leave, show that in June an average of 4,500 people each day were experiencing such a delay – down almost a quarter from the same month two years ago.

NHS leaders now want to quadruple progress on delivering shorter stays, with a suite of resources and activities designed to help hospital staff plan the right care and interventions – including wherever possible avoiding a hospital admission completely.

Dr Taj Hassan, president of the Royal College of Emergency Medicine, said: “The ‘Why not home? Why not today?’ campaign is really important in helping staff to make sure patients are discharged promptly if it is medically appropriate.

“The drive to get patients back to where they want to be – home – and free up bed space for other sick patients, is essential.

“A greater length of stay increases the risk of hospital acquired infections and further illness. We know that extended stays in a hospital bed can lead to significant muscle loss, particularly in older people, so ensuring that patients do not stay any longer than they need really is vital.

“Not only is this good for the patient but it allows other, sicker patients to be admitted; improving flow and waiting times in our Emergency Departments in the process.

“RCEM encourages all staff to think ‘Why not home? Why not today?’”

The campaign, developed in partnership with Royal Colleges, the Local Government Association and patient groups like Age UK, will therefore focus on reminding ward staff of five principles when planning care:

  • Planning for discharge from the point someone is admitted, and ensuring that plan is shared with the whole team and the patient;
  • Involving patients and their families in discharge decisions, and telling them the benefits of leaving hospital at the right time;
  • Identifying frail patients as soon as possible and making a specific plan for their care;
  • Having weekly multi-disciplinary team reviews for all long stay patients, and;
  • Encouraging a ‘home first’ approach, including assessing people at home where possible.

This campaign will complement a range of other measures being implemented across the health service as local areas set about delivering the NHS Long Term Plan, such as community response teams providing proactive support to keep people well at home, same day emergency care units providing rapid tests and treatment for common conditions without the need for an overnight stay, and digital tools to speed up finding care home places for those who need extra support after a hospital spell.