If you go into hospital, you may be worried about whether you'll cope when you leave.
You shouldn't be discharged from hospital until:
- You are medically fit (this can only be decided by the consultant or someone the consultant has said can make the decision on their behalf).
- You have had an assessment to look at the support you need to be discharged safely.
- You have been given a written care plan that sets out the support you'll get to meet your assessed needs.
- The support described in your care plan has been put in place and it's safe for you to be discharged.
Each hospital has its own discharge policy. You should be able to get a copy of this from the ward manager or the hospital's Patient Advice and Liaison Service (PALS). A hospital's discharge policy should state how patients and carers are involving in discharge planning. You can decide whether you want a family carer involved in decisions about your future care.
If you have limited capacity to make your own decision, the Mental Capacity Act will apply. It is worth thinking about appointing a deputy or enacting a welfare power of attorney before you go into hospital.
Before you go into hospital
If you're due to go into hospital in a planned way, such as for an operation, planning for what happens afterwards should happen before you ever arrive at the hospital. For unplanned admissions, such as if you've had a fall and hurt yourself, discharge planning should begin on the day you're admitted to hospital.
You'll usually be given an estimated date of discharge within 24 to 48 hours of being admitted to hospital. Your progress will be reviewed and, if there's likely to be a change to your discharge date, you should be kept updated. Read more about what happens after surgery.
The person co-ordinating your discharge for should be available each day, and you should be given their name and details of how to contact them. They are sometimes called "discharge co-ordinators" or "ward co-ordinators".
Hospital discharge assessment and care plan
A discharge assessment looks at the needs you are likely to have when you're discharged or transferred from hospital. Many people only need a small amount of support when they leave hospital, but others will need a more comprehensive package of care.
If you are likely to have ongoing health and social care needs when you leave hospital, the assessment may be carried out by a multidisciplinary team of health or social care professionals.
Depending on your needs, the multidisciplinary team could include a social worker, physiotherapist, occupational therapist, speech therapist, mental health nurse or dietitian.
You should be fully involved in the assessment process, and your views should be listened to. With your permission, any family carers will also be kept informed and given the opportunity to contribute.
If you would like help putting your views across, an independent advocate (for example, from a charity such as Age UK) may be able to help.
A care plan will be drawn up, detailing the health and social care support for you, and you should be fully involved. The care plan should include details of:
- the treatment and support you will get when you're discharged
- who will be responsible for providing support, and how to contact them
- when, and how often, support will be provided
- how the support will be monitored and reviewed
- the name of the person who is co-ordinating the care plan
- who to contact if there's an emergency or if things don't work as they should
- information about any charges that will need to be paid (if applicable)
What might be in a care plan?
The types of support in someone's care plan will depend on their assessed needs and preferences. A care plan could include:
- Community care services from the local authority, such as reablement services: An assessment for these must be arranged if it seems that you may need them.
- NHS continuing healthcare.
- NHS funded nursing care.
- Intermediate care: This is short-term care that's provided free of charge for people who no longer need to be in hospital but may need extra support to help them recover. It lasts for a maximum of six weeks and can be provided in someone's home or in a residential setting.
- Other NHS services, such as rehabilitation or palliative care.
- Equipment such as wheelchairs, specialist beds, or aids and adaptations for daily living.
- Support from voluntary agencies: Some organisations such as Age UK and the Red Cross provide "home from hospital" services that can help with household tasks or shopping while you settle back home.
- Care and support that's paid for privately. This may be an option you aren't eligible for help from the local authority.
Carers' involvement in hospital discharge
If someone you know is in hospital and about to be discharged, you should not be put under pressure to accept a caring role or take on more than you're already doing if you are already their carer.
You should be given adequate time to consider whether or not this is what you want or are able to do. If necessary, you should ask for other arrangements to be made while you are reaching a decision.
If you decide that you are going to provide care for the person who is being discharged from hospital, you're entitled to your own carer's assessment from social services. It is possible that your carer's assessment will be done over a period of time, beginning before the person you're looking after is discharged from hospital and continuing once they are home.
When you are discharged from hospital
On the day of discharge, the person co-ordinating the discharge should make sure that:
- you (and a carer if you have one) have a copy of the care plan
- transport is arranged to get you home
- any carers will be available if needed
- your GP is notified in writing
- you have any medication or other supplies you'll need
- you've been trained how to use any equipment, aids or adaptations needed
- you have appropriate clothes to wear
- you have money and keys for your home
If you are being discharged to a care home, the care home should also be told the date and time of your discharge, and have a copy of the care plan.
After discharge from hospital
Your care should be monitored and reviewed as set out in your care plan. The care plan should also include details of who to contact if things don't work as planned.
If your care plan includes community care services from a local authority, it should check that their care package is working well within two weeks of discharge. If you live alone, this should take place within the first few days of discharge. Following this, your care plan should be reviewed at least annually.
Complaints about hospital discharge
You might not be happy with the way your discharge from hospital is being handled. For example, if:
- the hospital plans to discharge you before you think it's safe
- there isn't enough support in your care plan
- you don't think your discharge assessment and care planning was carried out correctly
If you are in this situation or you have concerns about someone else who is still in hospital, it's best to raise them straight away so that they can be addressed as soon as possible. Speak to the person who is co-ordinating the discharge, or the supervising consultant.
You may find it helpful to get support from the hospital's Patient Advice and Liaison Service (PALS) or your local Independent Health Complaints Advocacy service.
If you want to complain about how a hospital discharge was handled, you could start by speaking to the staff involved to see if the problem can be resolved informally. Find out more about the NHS complaints process.
Article provided by NHS Choices