Hospitals may have to discharge patients earlier in order to ‘maintain flow’ during upcoming junior doctor strikes, according to NHS England leaders.
They indicated that conversations around early discharge are necessary despite being ‘difficult and uncomfortable’.
The BMA’s junior doctors committee recently announced further strike dates over the Christmas period and in the new year after rejecting the Government’s latest pay offer.
At NHS England’s public board meeting last week, directors called it the ‘worst possible time of the year for this to happen’ and laid out priorities for systems over the coming weeks.
Interim chief operating officer Emily Lawson said the priority should be on urgent and emergency care, critical care, neonatal care, and maternity services.
As well as rescheduling appointments and procedures due to the strikes, Ms Lawson highlighted the impact on discharging patients, which she said is ‘critical to keep the flow into A&E and out of hospital on the other end’.
National director of patient safety Dr Aidan Fowler said: ‘Where there is risk across the system we’ve got to make sure that’s balanced in the best possible way for patients.
‘So that will sometimes mean perhaps earlier discharge for patients in order to maintain that flow at the front door where we’ve got critically ill people, and in order for them to be able to come through into the system to receive care.
‘And I recognise those conversations are difficult and uncomfortable but they need to be had.’
Ms Lawson also emphasised that any decisions should be made ‘in line with clinical judgement’ and clinicians should be given the ‘space’ they need to make those decisions.
A similar approach was taken during the Covid-19 pandemic in 2020 when NHS England instructed hospitals to discharge patients early to create more capacity for those with the virus.
And at the start of 2022, NHS England pushed for patients to be discharged earlier from hospitals to free up beds during a rise in Omicron cases, but the BMA warned this could have a destabilising effect on GP practices.
Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said this proposal could ‘alleviate pressure on hospitals’ and release beds, but it could also be ‘disruptive’ for patients.
He told Pulse: ‘It may increase the risk of adverse events and readmissions in patients who are discharged too early; and before they have recovered adequately and have suitable support in the community.
‘Discharge planning requires close coordination between hospitals, primary care providers, and social care services. It is important to carefully assess each patient’s individual needs and circumstances before making a decision about discharge.
‘Patients and their families should also be involved in the decision-making process and should receive clear information about what to expect after discharge.
‘Robust mechanisms for monitoring and follow-up post-discharge are essential. This includes clear instructions for patients on when and how to seek help if their condition worsens.’
‘The NHS faces the same winter pressures each year and it is disappointing that no long-term solutions have yet been found, only a collection of short-term fixes,’ Professor Majeed added.
Ahead of the ambulance strikes over Christmas last year, NHS leaders urged hospitals to discharge as many patients as possible.
New junior doctor strike days were announced last week following five weeks of negotiations between the BMA and the Department of Health and Social Care.
Junior doctors rejected the Government’s offer of an additional 3% on top of the average 8.8% increase already awarded this year.
The walkouts will take place for three days from 20 December and six days from 3 January – the January strike will be the longest of the industrial action so far.
Earlier this year, the national commissioner confirmed it is developing a ‘national standard for rapid discharge’ from hospitals, but concerns were raised about the impact on general practice with GPs potentially picking up a larger share of the workload.
By “maintain flow” we probably mean unsafe discharge with merry go round re-admission??
IC is so right. This means unsafe and daft situation of more readmissions, and ignore extra burden of unsustainable work
burden shouldered by GPs yet again. Tory cruelty on patients and their concerned families who are not daft and this been happening for many years; indeed vote them out or you deserve more of tthis everyone.
Elderly patient with acute MI self discharged from A&E yesterday. Troponins 25000. Called me this morning asking for pain relief. When I asked why he signed himself out he said he waited seven hours, they only have him aspirin and ‘had no beds’ for him.
I sent him back. Surely this is not an isolated case.
The bods coming up with these directives can’t resist the phrase ” in line with clinical judgment.”
Usual silence from the bastions of quality GMC,CQC.
Just as well we know what we are up against!!
Reality bites:-
There are insufficient hospital beds because there are insufficient hospital beds – Obvious?
NHS hospital beds in 1974 = 400,000: in 2021 = 141,000. A reduction of 64%
UK Population in 1974 = 56 million: in 2021 = 67 million. An increase of 19.5%
Does Covid et al have anything to do with it or has it been successive Governments’ mismanagement?
Anonymous – you have come across a case of culpable medical negligence, and I hope GMC takes note of the responsible Hospital General Manager for action.
NHSE could prevent adverse effects of all strikes by immediately making an acceptable offer to the staff. If any patient is discharged unsafely or too early, it is the fault of NHSE for failing to take required actions. (Are there any GMC-registered persons on NHSE board?)
This is just a divisive and below-the-belt move by NHSE to divert blame onto innocent exploited employees.
If anything, strikes are likley to delay discharges, but if government sorted out home care, support services, etc, and provided enough beds, they could easily fix all those problems and improve patient flow miraculously.
It appears to be an incident of top-level bullying at work by top level managers, that should be called out and result in sackings (without compensation – they earn too much anyway)