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Claim that hospitals 'chuck out' 400 patients a night

Hundreds of thousands of patients are being sent home from hospital in the middle of the night, despite a promise to cut down on the practice.

More than 300,000 people have been discharged from hospitals between 11pm and 6am since 2012, an average of 400 a night.

Many of them are elderly, giving rise to concerns that vulnerable people may be unsafe or struggle to get home at unsociable hours.

“Discharging patients at night without appropriate support is unacceptable”

NHS England spokesman

The figures, uncovered through Freedom of Information requests by Sky News, revealed that in almost half of cases the proportion of patients discharged overnight also increased.

Some 72 of England’s 160 NHS trusts provided figures for all three years, suggesting that the true number of patients discharged during the night is likely to be much higher.

Of the 72 trusts that replied, 152,472 patients were discharged between 11pm and 6am in 2011-12, rising to 152,479 in 2013-14.

The figures also revealed that 20,152 of those patients were aged over 75 in 2011-12; 19,728 in 2012-13 and 18,548 in 2013-14.

In 41 cases the number of patients discharged overnight increased, while in 31 cases the proportion of patients discharged between 11pm and 6am increased.

The proportion of patients discharged overnight remained the same at 2.41%.

In 2012, Sir Bruce Keogh, NHS England’s medical director, called on hospitals to reduce the number of patients being discharged overnight.

He said at the time: “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.”

Bruce Keogh

The NHS was accused of persisting in the widespread practice to help free up beds for other patients.

Dr Mike Smith, chair of the Patients Association, told Sky News: “It’s for the convenience of staff and the person they are admitting but at the gross detriment to the person they are chucking out.”

Nadra Ahmed, chair of the National Care Association, said discharged patients often ended up in care homes during the night.

She said: “They are going back without any relevant information about how their care might have changed, what the diagnosis might have been, their paperwork is not following because people are off duty and often without the relevant medication they need for the following day or even through the night.”

A spokesman for NHS England told Sky News: “Discharging patients at night without appropriate support is unacceptable, particularly if a patient is vulnerable.

“Where a patient wishes to leave late at night or early in the morning, it should be accommodated only where it is safe and clinically appropriate and with the support of family, friends or carers,” he said.

“The decision to do this should always be based on what is best for the patient.”

Readers' comments (21)

  • Just this week, my parents overheard a 95 year old being told that they would be discharged at 10pm that evening.
    Is this really acceptable?

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  • I wondered if they had counted patients being discharged from A&E in these figures? If that is the case then surely these should not be included? A&E is meant to be a location of temporary care; not were patients are admitted to. If for instance, you gashed your head open at 18.00 and were seen in A&E and had treatment and were then sent home at 21.30 would this constitute the hospital 'chucking you out'? Of course I am sure this practice goes on but not sure of the numbers being given?

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  • To me this just shows the crisis we have with lack of beds in our Hospitals. We can blame Hospital staff OR we can look at the bed crisis and how to resolve it.

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  • clearly more beds and more staff needed. reported over the years that wards have been shut and are lying idle. what is the point of building hospitals, overfilling them and then having empty wards and insufficient personnel to staff them?

    a documentary on European tv last night showed all of the attention and care lavished on immigrants by social services and the NHS. perhaps this is why care of the elderly is so lacking as the hands of these services are already full and all of their energies seem to be directed there. some arrive in a dire social condition and state of health so they cannot be begrudged or denied such service as their cause can be very acute but there needs to be adequate resources and facilities to cater for everybody.

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  • I work for a care home company, a few weeks back we had to send a resident in to A&E following a fall with ?head injury. At 3am the home received a call from the department to inform us that they were sending the resident back to us. This is a disgusting practice, I struggle to understand their decision process of sending a Vulnerable adult home in the very early hours.

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  • Anonymous | 22-May-2014 4:59 pm

    apart from the risks, discomfort and poor care of the patient it is a total lack of respect and regard from the staff in your home who may be unable to accept such a rapid return in the early hours when the staffing levels are lower.
    Hopefully they at least organised the transport.

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  • yet another sensationalist and appalling headline. one would imagine from NT greater professionalism.

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  • I work in a community hospital caring for elderly patients. One late shift recently we were expecting a patient from another hospital, for rehab following #neck of femur! the patient also had a degree of dementia. At 9pm we had a call asking what our cut off point was for admissions! The transport wasn't there and the very earliest the patient would arrive would have been 10.30. I questioned the fairness to the patient and said we'd be happy to accept the patient the following morning! Told them in certain terms that it was most inappropriate!

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  • tinkerbell

    all this must be down to wicked doctors and nurses and not ruthless managers obeying the puppet masters, nor a government of spivs who is underfunding the nhs to sell it off to their mates. Bad, bad NHS, as usual. Sorry but all this propaganda is getting very boring whilst the real culprits should be named and shamed.

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  • Unfortunately, this practice definitely happens, with little or no consideration for the needs of the patient who is being discharged.

    An elderly (90+) friend of mine was in hospital having suddenly lost most of her sight. One night she was woken at midnight and told that she was going home. She lives on her own and had not yet learned to cope with her blindness.

    She was put on a trolley in a 'holding bay', as she describes it. She didn't know where she was or where anything was. She wanted the toilet but had no idea how to get to it. Fortunately, a 'lovely' HCA noticed and sat with her and helped her. She was there all night and in the morning the consultant was furious that she had been moved.

    Imagine how frightening this must be for anyone, let alone a frail, elderly person!
    Of course, she couldn't be returned to her former bed as that had already been allocated to someone else, so she had to start to familiarise herself with her surroundings and the staff again.

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  • Trish | 23-May-2014 9:41 am

    appalling, inhumane and cruel.

    if a veterinary clinic treated peoples' pets in this way there would be a huge outcry but then I suppose clients are paying up front for their patients.

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  • I'm not for it - I'm not against it, but for some this must be a good thing, surely it's better to sleep in your own bed with your own surroundings and be disturbed for one night in your life, than trying to sleep in a hospital chair, or on a trolley just for the sake of not going home in the dark.
    Have we really got to the stage where one night disturbed sleep is the end of the world, when we were young we used to think it was fun, or an adventure.
    My grandma had altzheimer's and was always much better in her own surroundings, and she didn't care what time of day it was anyway.

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  • Hi I worked in Kingston Hospital in the the mid 1990s. As a unit manager on a medical floor I stood my ground and said it was inhumane to move an 85 year old confused man to a nursing home at 2am I was absolutely vilified and abused for it by management. When I still stood my ground I was told that my attitude was wrong and that I was not considering poor patients in ED my response was that my duty was to my patients in my care and that I was not responsible for a failure of processes that led to overcrowding in ED.
    I am proud that I stood my ground I left kingston shortly afterwards completely disillusioned at a system that viewed patients as numbers

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  • The question asked, I believe, was the same one as last time two years ago: How many patients are discharged between 10pm and 7 am?

    The problem is that the results fail to show how many were discharged from A&E, how many self discharged and how many had died. So, the 93 year old lady (for example) who died at midnight, then confirmed dead at 2am would be shown as discharged at 2am.

    This is sensational journalism at it's best.

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  • I work in A&E and we often admit patients because we can't get them home at night! Many people refuse to collect their elderly relatives at night and I even had a nursing home refuse to take a patient back because it was after 9.30pm, even though we offered to provide an ambulance.
    We can't keep people in hospital just because it's dark outside: we need a patient transport system that is able to take the patient home, settle them into their bed or chair, make a cup of tea and ensure they are safe.

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  • Attracta Gorman | 23-May-2014 12:03 pm

    very well said. non-clinical management are strategists not carers! they are interested in getting the job done and providing minimal resources to do it but not in the least interested in human frailties and sensitivities. for them it is a job done with little regard for how those held responsible achieve it.

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  • Anonymous | 23-May-2014 12:31 pm

    if they are sick enough to come to A&E they need to be kept in overnight for observation and then it is determined who can go home during a clinical round the next morning. is it true your A&E departments in the UK don't even have a unit with beds for overnight stays? in Europe patients who don't have their own transport home, who are unaccompanied and not well enough to go home stay overnight in a bed in a proper A&E ward for observations until they are declared fit for discharge or admission to a ward where there is a vacancy for them. only in the event of a large scale emergency would patients be admitted to the wards at night when the A&E bed area is full and only after proper assessment but then we didn't leave sick and injured patients to linger for hours on end in corridors and on trolleys without medical or nursing attention!

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  • Hopefully all ED stays are temporary. In + out relatively quickly.
    If any department is full they should stop all new admissions, as its unsafe for existing patients, new patients and staff. Ambulance services must be informed when an ED is closed and go elsewhere.
    It's concerning with inappropriate admissions are tying up resources where very unwell casualties need to get into EDs.
    Inappropriate stays + treatments should be billed (through patient, insurance schemes, or deductions via other sources) that way emergency care + critical treatments can be delivered free at point of access.
    Yes vulnerable people shouldn't be made to go an empty home in the middle if the night. But if family are present or for a nursing/residential home- it isn't empty. Nursing/Residential homes take enough money from each person as it is, and staff should be there to help the odd person back in.
    Bills to social services should be made for all delayed discharges from time someone is medically fit for discharge by medics.

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  • You have to have experienced this with one of your elderly and/or vulnerable relative to fully appreciate the negative impact on this practice. I appreciate my own bed after a late night/shift, but would feel very vulnerable if I was unwell. The majority of the public would not wake up their family in the middle of the night, as wouldn't want to bother them.

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  • Anonymous | 26-May-2014 0:39 am

    you don't have to have experienced this with one of your elderly relatives to fully appreciate the negative impact on this practice at all. it is good basic common sense and respect for others and treating them decently and humanely. you just need to be a normal decent caring human being in possession of a very little common sense as well as a clinician who understands the risks and discomfort to the patients and professional enough to stand up to your managers!

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