Discharge of Over 75-Year-Olds from Nottingham Hospitals

Key findings

• While hospital care itself was generally praised, most patients and relatives felt they had not been well informed or involved in discharge planning, and rarely had written information about their options.
• Only 3 of 29 people said they had received the "Home First" factsheet explaining social care support available to help patients leave hospital.
• Communication breakdowns caused confusion and anxiety — particularly around who was coordinating discharge, and changes to medication not being properly communicated between hospital, GPs and pharmacies.
• Delays waiting for hospital pharmacy or care packages caused frustration and added strain for both patients and relatives, and some patients said extended hospital stays worsened their mental health, mobility, and confidence.
• Where available, the Discharge Co-ordinator, ward receptionists, and support services like the Hospice and Connect were consistently valued for making the process smoother.
• Patients with dementia sometimes appeared able to manage independently during assessments, while family members felt their fuller support needs weren't being recognised or listened to.
• By the follow-up interviews a month later, most patients reported settling in well at home, though some remained unclear what would happen once short-term reablement support ended.
• Living alone was common among those interviewed, and neighbours, family, and local support networks played an important role in helping patients cope after discharge.

Recommendations

• Consider adopting a discharge checklist, such as Healthwatch Surrey's "Leaving Hospital" model (NUH).
• Ensure everyone who needs the Home First factsheet receives one and understands its purpose (NUH).
• Improve the medication process on discharge to reduce delays on the day of leaving hospital (NUH).
• Ensure relatives and carers are included in discharge planning where appropriate (NUH).
• Ensure patients and relatives clearly understand the difference between reablement, short-term support, and ongoing care packages, including costs and timing (Social Services).
• Improve communication between NUH and community health services to maintain continuity of care, e.g. continence services and GP surgeries (NHS).
• Explore how the voluntary and community sector (VCS) can support people being discharged, particularly those living alone (whole system).
• Recognise and build on the value patients and families place on roles like the Discharge Co-ordinator, ward receptionists, the Hospice, and Connect (whole system).