Overnight discharges from NHS hospitals to be examined

Roswyn Hakesley-Brown, Patients' Association: "It is a very worrying situation indeed"

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The government is investigating after figures emerged suggesting that hospital patients in England have been discharged overnight to free up beds.

The Times newspaper discovered, via Freedom of Information requests, that 100 NHS trusts sent 239,233 patients home last year between 23:00 and 06:00.

NHS medical director Prof Sir Bruce Keogh said people should be sent home only when it was appropriate and safe.

The paper had contacted 170 NHS trusts in England but only 100 responded.

However, the rates of those discharged varied widely between different hospitals.

No warning

The paper reported that some 3.5% of all hospital discharges took place between those hours and this rate had steadily held for the past five years.


On the face of it, it seems shocking that patients are being discharged at night. The data obtained by The Times suggests this may be happening in 3.5% of cases.

But that needs putting into context. It seems some hospitals are including patients who have died in their figures, while some patients, such as women who have had a baby, may choose to leave at night.

Nonetheless, it is clear there are also many cases of inappropriate discharges.

This reflects the pressure hospitals are under. Admissions to A&E units have been rising for years - and if more people are coming in, more have to leave.

The problem is compounded by the fact hospitals have very little wriggle room. They are supposed to operate at only 85% capacity, but all too often they are closer to 100%.

It means when there is a surge in patients, there is no leeway in the system - and something has to give.

If the remaining 70 trusts discharged their patients at similar rates, this would add up to 400,000 such discharges a year and almost 8,000 a week, the paper added.

Derby Hospitals Foundation Trust sent 8.7% of its patients home overnight but the trust told the Times there may have been a problem with its records.

Others with rates above 7% include the Heart of England NHS Foundation Trust in Birmingham and Countess of Chester and University Hospitals of Leicester trusts.

Newcastle Hospitals Foundation Trust and Southend University Hospital Foundation Trust both said they did not discharge patients during the night.

Variable data

One trust, which did not want to be identified, told the BBC that some of its patients had been in assessment units for further checks after being brought in as emergencies - and they were allowed home because they hadn't been formally admitted as inpatients.

The Times does state that the data is variable and while some hospitals admitted to keeping detailed records, others said they could not guarantee the accuracy of the figures as details were not necessarily recorded accurately.

The paper also adds that some hospitals categorise deaths as "discharges" while others do not.


"It was very common for residents to be returned after midnight.

On one occasion it was disgraceful as the weather was extremely cold and we did make a formal complaint but nothing came of it.

Sometimes because of the time the resident would become quite confused and unable to settle.

It has to be said the ambulance crews were often embarrassed.

Also, prior to discharge they would be kept waiting in a chair for hours for the ambulance to become available.

It was clear the health and well-being was low in their priorities."

Sir Bruce said: "I am concerned to hear that some patients may be being discharged unnecessarily late.

"Patients should only be discharged when it's clinically appropriate, safe and convenient for them and their families.

"It is simply not fair to be sending people home late at night. We will look at this."

Dr Mark Porter, of the British Medical Association, said the figures illustrated the "enormous pressure" the health service was under.

The Patients Association reported that it had received regular calls from people who had been sent home from hospital without any warning late at night.

The organisation's chief executive Katherine Murphy said the situation was unacceptable, the Times reported.

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