Hospitals must end 'potentially dangerous' night discharges, MPs say


Jeremy Hunt must set out how he intends to stop hospitals discharging patients in the middle of the night unless they specifically want to go home, MPs have said.

The Public Administration and Constitutional Affairs Committee (PACAC) said night discharges between 11pm and 6am are "potentially dangerous" for patients and called on the Health Secretary to take action.

The PACAC was responding to a report in May from the Parliamentary and Health Service Ombudsman (PHSO) which detailed how frail and elderly patients are being discharged from hospital while they are still unwell or unable to cope.

The PHSO - which saw a 36% rise in discharge-related investigations in 2015  - found that some deaths and incidents of suffering could have been prevented if hospitals carried out the right checks before discharging people.

In one case it investigated, a woman in her 80s was discharged from hospital to an empty house, in a confused state with a catheter still in place. Another woman, a grandmother in her late 90s, collapsed and died in her granddaughter's arms after being discharged from hospital too soon.

Another hospital sent an 85-year-old woman with dementia home alone at 11pm, without informing her family, despite the fact she was unable to look after herself.

In its new report, the PACAC said it had received evidence on discharges from the Alzheimer's Society.

It said: "We agree with the Alzheimer's Society that night discharges are potentially dangerous for patients, and detrimental to their carers and relatives. Whilst we are aware than an outright ban on night discharges might have unintended consequences, the Secretary of State for Health must set out, in the Government's response to this report, how he intends to ensure that only those who want to be are discharged between 11pm and 6am."

The PACAC also found that the PHSO cases were "not isolated incidents but rather examples of problems that patients, relatives and carers are experiencing more widely".

It argued that "pressures on resources and capacity within hospitals are leading to worrying and unsafe discharge practices" and called for person-centred care to be "the undisputed priority" across the NHS.

The report also criticised the lack of integration between health and social care, saying: "At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration."

MPs said poor patient discharge can take the form of both delayed transfers of care - where patients are kept in hospital despite being medically fit to leave - and early discharge, where patients are discharged before they are fit or before support is in place.

Figures released in August showed that delays in discharging fit patients from hospital have risen 23% since June last year.

PACAC chairman Bernard Jenkin, Conservative MP for Harwich and North Essex, said: "Hospital staff seem to feel pressured to discharge patients before it is safe to do so. Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge."

Janet Morrison, chief executive of the charity Independent Age, said: "This report paints a damning picture of the management of hospital discharge across many parts of the NHS. We are consistently seeing record numbers of people being kept in hospital unnecessarily because appropriate care services have not been put in place.

"Elsewhere, the worrying "revolving door" approach means people are being rushed out of hospital too soon as the race to find beds takes priority over patients' needs. Sadly, frail patients who weren't even ready to leave only find they end up back in hospital again."

A Department of Health spokeswoman said: "Patients should only be discharged from hospital when it's clinically appropriate and safe for them and their families - and the best way to ensure that is to meaningfully integrate health and social care.

"We are investing billions to do so over the course of this Parliament to improve the experience of patients, many of whom will be vulnerable."