Can a hospital discharge someone before care is arranged?

Discharge is the point at which most things go wrong in later-life care — falls, deterioration and readmission cluster in the days afterwards. Hospitals must ensure appropriate support is in place before you leave, and you are entitled to say that a proposed discharge is unsafe.

What should happen

• A care needs assessment should be offered where you appear to need ongoing support. Under Discharge to Assess, that assessment often happens after discharge — at home or in a step-down facility — rather than on the ward, which is lawful, but the interim support must still be adequate.
• Reablement, usually up to six weeks of intensive support to rebuild independence, is normally free. It is not always offered automatically: ask for it to be considered in the discharge plan.
• Equipment, medication, transport and follow-up should be arranged and explained before you go.

Where a person cannot decide for themselves

A person with capacity chooses where they go after hospital — a hospital cannot discharge them to a care home against their wishes. Where someone lacks capacity, a best interests decision must be made under the Mental Capacity Act, involving family and any attorney or deputy. A placement chosen for convenience, without that process, is challengeable.

Ask on the ward whether a continuing healthcare checklist has been completed where health needs are complex — and if the person is approaching the end of life, ask about the CHC Fast Track, which can put fully NHS-funded care in place within 48 hours. An assessment carried out while someone is not clinically stable should be deferred rather than decided against them.

If the discharge goes wrong

Patients are not generally charged for remaining in an NHS bed, though where you are medically fit for discharge the hospital will press to move things along; in practice the focus is on finding community support rather than legal action.

Where an unsafe discharge has caused harm, complain to the hospital’s complaints team and then to the Parliamentary and Health Service Ombudsman. If the harm is serious, take advice from a clinical negligence solicitor as well — and put your account of the discharge in writing while the detail is fresh.