What is an unsafe hospital discharge in the UK?

Too many people experience an unsafe discharge from hospital in the UK, resulting in harm to the individual needing care. This article explains what is an unsafe hospital discharge and what you can do about it.

Key Points

• An unsafe hospital discharge occurs when a patient is sent home before it is medically or practically safe.
• Unsafe discharges can lead to harm from falls, medication errors, isolation, lack of care and hospital readmissions.  
• NHS guidance and the Care Act 2014 require early discharge planning involving patients, family and carers and a discharge coordinator oversees discharge arrangements.
• Families should request assessments and communication before discharge and raise any concerns with the discharge coordinator and PALS.

What is an unsafe hospital discharge?

An unsafe hospital discharge in the UK happens when a patient is sent home from hospital before it is medically or practically safe to do so.

Why do unsafe discharges happen?

Early discharges can happen because of pressure to make beds available to reduce waiting times, lack of communication between hospital, carers and family, inadequate assessment of your ability to manage at home and lack of care packages available.

Reasons for unsafe discharges from hospital

• You are discharged too early, before being medically ready.  
• You are not assessed and diagnosed or misdiagnosed before discharge. 
• Relatives and carers are not informed in advance that you have been discharged.
• You are sent home late at night or at weekend, when services you may need are unavailable e.g. transport to get you home, pharmacy services for your prescription.
• There is no home care plan or any other care in place when you are discharged.
• Your care plan is not communicated to family or carers.
• Medications have not been explained to the patient or prescribed correctly.
• Essential home adaptations/equipment (e.g. mobility aids) have not been arranged.
• You are released from hospital when you have no home to go to, making you homeless.  

Safe discharge	Unsafe discharge
Medically stable and fit to leave hospital.	In pain or symptoms unresolved.
Medications explained and given.	No medication or unclear instructions.
Follow-up plan and contacts.	No handover to GP or care team.
Carers/family informed in advance.	Family/ carers not informed of discharge.
Moved during daytime hours.	Discharged at night or over the weekend
Support at home arranged (e.g. carers, aids).	Return home to empty house with no care.

What happens if an unsafe discharge takes place? 

Unsafe discharges leave the person at risk of falls/harm/ill health, isolation, medication errors, lack of food or/and readmission to hospital.

Examples of failed hospital discharges

• Discharged at night and family/carers not informed:

A 90-year-old woman with dementia was released at 11 pm, and her daughter was not informed.

She was alone in the house the next morning, there was no food, no heating and no care.

• Carer not informed:

A woman in her late 70s was moved out of hospital when her carer was away.

She had no medication, no food and didn’t know what to do.

• Misdiagnosed:

A woman in her 90s was sent home with chest pain. She collapsed and died.

The NHS has guidance on hospital discharge. When it comes to the NHS discharge process, it says planning for a hospital discharge should start upon admission.    

Section 74 of the Care Act 2014 states that where a trust is responsible for an adult hospital patient and considers they are likely to require care and support following discharge from hospital, the trust must make plans relating to the discharge and take any steps to involve the patient and their carer(s).

NHS England warns against hospital transfers during the night. This is because most services are unavailable, making risks to care higher.

What happens if you do not have mental capacity?

The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16+.

Examples of people who may lack capacity include those with dementia, a severe learning disability, a brain injury or a mental health condition.

The MCA says if you make a decision for someone who does not have capacity, it must be in their best interests. Any treatment and care given should be the least restrictive of their basic rights and freedoms.

A lasting power of attorney (LPA) is a legal document that allows someone to appoint one or more people as their attorney to help them make decisions or to make decisions on their behalf if they lack mental capacity. 

Who decides my discharge from hospital?

Your hospital consultant decides if you’re well enough to leave hospital.

A discharge coordinator manages your discharge and factors involved in it. They are your main point of contact for matters involving your discharge.

A safe discharge can involve the discharge coordinator informing your GP, organising where you are being discharged to and arranging your transport, money, house keys, clothes etc.

Arranging follow ups to ensure that you have settled in well and that your post-hospital care is on track. 

Arrangements for your discharge can involve other health and care professionals.

They can include an acute discharge case manager for people who need very specialist support after discharge and a rehabilitation support worker who monitors how you are managing with daily living. It may also involve a nurse, pharmacist, physiotherapist, mental health practitioner and a housing specialist.

What is a discharge plan?

A hospital discharge plan covers your existing needs and how they may change in the future. It covers what support you need, by whom, any equipment that needs to be provided for you and when the plan needs to be reassessed.  

Your discharge plan should be created before your consultant says you can leave hospital.

What is Discharge 2 Assess (D2A)?

D2A is a model where people with new or additional health and/or social care needs on hospital discharge receive post-discharge recovery support.

In England, there are three pathways:

1- Leaving hospital to go to your own home.

2 – going from hospital to a short stay somewhere else to recover.

3- leaving hospital to go to long-term residence that offers permanent care e.g. a care home.    

6 weeks free care after hospital  

If you are due to be discharged from hospital in the UK, you may not realise that you may be entitled to up to 6 weeks free care after hospital.

What can families do to stop a risky hospital discharge? 

Families must ask the right questions and challenge risky hospital discharges.

If you believe a discharge is unsafe:

• Ask for a discharge assessment. Everyone should be assessed before leaving hospital.
• Ask for a written care plan detailing support arrangements and contact points.
• Involve the local authority if post-hospital care or home adaptations are needed.
• Search for trusted home care providers on homecare.co.uk to find rated, reviewed care options near you.

To reduce the risk of an unsafe discharge from the hospital in the UK, before you (or your relative) leaves hospital, ask hospital staff:

• What is the diagnosis and has it been explained to me/them?
• Are you/ your family member medically fit to be discharged?
• Has a written discharge summary been given?
• Has your/their carer/family been informed in advance?  
• Who will assist you/them at home?
• Is the correct medication been prescribed and is any medication going with you/them?
• Does your/their carer know how the medication must be taken?
• What time will the discharge take place. Is this an appropriate time to access services they need?  
• What transport has been arranged?
• Has a follow-up appointment or visit pre-arranged?
• What will happen if something goes wrong?
• What is the hospital discharge policy supporting this?
• What home care equipment (e.g. crutches etc) have been arranged?

How can I challenge a hospital discharge?

• You have a right to challenge the decision.
• You can talk to the discharge co-ordinator or PALS team. The Patient Advice and Liaison Service (PALS) at your hospital.  It offers confidential advice, support and information on health matters to patients, their families and their carers.
• You can request a review or delay in the hospital release.

What can I do if I have been discharged from hospital without help?

If you or a family member is at risk, after being discharged from hospital:

• Contact your GP or NHS 111.
• Ask your council for emergency social care support.

If you experience an unsafe hospital discharge, you can report this to the hospital or the Care Quality Commission (CQC) or the relevant care regulator for the UK nation where you live.

How do I complain about an unsafe discharge from the hospital?

If you want to complain about how a hospital discharge was handled, speak to the staff involved to see if the problem can be resolved informally.

Alternatively, speak to the Patient Advice and Liaison Service (PALS) at your hospital.

How can home care services help after a hospital discharge?

Having the right home care support in place is one of the most effective ways to ensure a safe and successful return home from hospital.

In particular, an older person who is discharged from hospital may be unable to understand or remember instructions such as medicine taking.

They may be physically frail and be unable to perform routine tasks without help from a carer.

They are also at higher risk of rapid deterioration, if their discharge is not safe.

Home care providers listed on homecare.co.uk can offer:

• Hospital discharge planning to help coordinate with NHS staff and social services.
• Short-term reablement care to help people regain confidence and independence.
• Medication management and personal care support.
• 24-hour live-in care for those with complex needs.
• Family updates.

By arranging care early, even before discharge, families can reduce the risk of readmission and promote a smoother recovery.

You can visit homecare.co.uk to find home care services that support a safe transition from hospital to home.