Digitally-enabled discharge: the human cost of failing to act

Embedding digital into hospital discharge is messy, it’s hard, there are a lot of moving parts but every improvement to our record on discharge is a real win, says Clare Morris

I’ll start with a confession. Hospital discharge is a passion project for me. As the chief officer of a CCG for five years, I saw first-hand what a turning point hospital admission can be in the life stories of our older people.

A hospital admission can be the highwater mark of someone’s need, but too often people leave their homes, their lives, in a blur of drama, and never return.

Research we conducted in Essex really shocked me: it showed very clearly that a hospital stay is a huge driver of demand for social care, and can have a profoundly negative impact on somebody’s long-term care needs.

People go to hospital to get well but we know from reams of research conducted internationally just how damaging it is if people don’t get home quickly once the acute phase of their medical care is over.

For every 10 days someone stays in hospital past their clinical need they sustain 10 years worth of decline in muscle function. One day kept in unnecessarily is equivalent to one year’s lost muscle tone. It’s worth taking a moment to let that sink in.

For older people a prolonged hospital stay decreases physical function. It increases their dependence. It can decrease their health-related quality of life.

We also know from research and surveys that older people want to live in their own home as long as possible. As Lina Ramsden, transformation lead for urgent and emergency care in the Midlands at NHS England and NHS Improvement, told our recent LGA Masterclass “Older people don’t fear death, they fear the loss of their independence.” So, if we want people to have good quality of life, getting them home quickly is just vital.

And here’s the thing: it’s in our gift to help that happen. The digital tools are within reach.

Right from the day of discharge, digital technologies can enable quicker, safer transition back into the home. At our masterclass Julie Harrison, commissioning manager for adult social care at Birmingham City Council, shared her team’s success with 750 OwnFones – digital wearables with a call function – to augment its busy telecare service.

Elsewhere, home sensors allow carers to track activity and progress between home visits and video carephones help families to check in, supporting the person through reablement but also beyond into their digitally-enabled future at home. In social care terms, digital support packages can maximise the number of people on ‘pathway 0’ – requiring little or no formal support.

In human terms, it can be the difference between slowly returning to their previous life, or accepting a new reality.

I absolutely believe technology to help people get home quickly and safely, to support their reablement and help them to stay at home, is vital. And yet it’s overlooked, it’s forgotten…it’s not embedded in our health and social care processes at the moment. I get why that happens.

Getting people home from hospital is a busy, pressured time for patients, families and staff. Taking the time to introduce technology might feel like a luxury. But it isn’t.

Pathways out of hospital will always be complicated. For hospital teams, the world can tend to stop at the car park; they don’t always appreciate how much amazing care is offered – and risk held – in the community.

For their part, local authorities have struggled to grasp the opportunity to embed transformative technologies in the discharge process (our resources on this site can support your journey towards digitally-enabled discharge).

There’s a huge opportunity for us to join this up better.

Getting this right will take an extraordinary level of co-operation and collaboration between social care and NHS colleagues, but the potential gains for older people and those who care for them are immense.

If ever we needed an incentive to step into the difficulty of joint working between the NHS and social care and technology, this must be it.

Clare Morris is a former NHS leader and co-founder of Rethink Partners, working with health and care organisations to visualise and implement change for good.

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