Thousands sent home from hospital in the middle of the night

Patients are being routinely sent home during the early hours of the morning by hospitals needing to free up beds, figures have shown.

Discharging in the middle of the night has been criticised by health groups who say it can add to anxiety and uncertainty for patients and their families.

They included elderly patients, some of whom were sent to care homes or hospices in the dead of night.

At Sandwell and Birmingham City Hospitals, both run by the Sandwell and West Birmingham NHS Trust, 13,116 patients were either sent home or to a care home or hospice between 10am and 6pm since the start of 2018, data obtained by the Express & Star revealed.

The vast majority - 12,999 - went back to their "usual place of residence". A total of 41 patients were taken to care homes or hospices. The destination of 12 patients was listed as "unknown".

In total 865 patients were discharged at night in November, including those who stayed within the healthcare system.

At Russells Hall Hospital, which is run by the Dudley Group NHS Trust, 2,512 patients were sent home during the same period during the last two years.

The total each month has gradually increased since June this year and during October 137 people were discharged in the middle of the night. During 2019 an average of 122 patients were discharged after 10pm.

A total of 10,682 were discharged from New Cross Hospital, run by the Royal Wolverhampton NHS Trust, though more than half of these were from A&E who did not need to be kept in. Of the total, 6,857 were adults and 3,825 under 18.

And 3,214 patients were discharged from Stafford's County Hospital and the Royal Stoke Hospital, both run by the University Hospital of North Midlands NHS Trust (UHNM)

Walsall Healthcare NHS Trust, which runs Walsall Manor Hospital, said it could not provide the information requested.

Some discharges may include patients who have arrived at A&E late in the day and have not needed to stay overnight.

Hospitals have come under increasing pressure to free up beds as the level of demand has increased during winter.

Sandwell and City Hospitals have been running at 100 per cent occupancy over recent weeks, meaning all beds are full.

Meanwhile, the pressure rating was escalated to the highest level four at New Cross earlier this month as all beds were also full. Staff were told the "emphasis is on increasing safe discharges".

Christine Szygowski, chief executive of Age UK Dudley, said she would be particularly concerned about elderly people being discharged at night.

She said: "It does almost seem barbaric to discharge patients who have been unwell in the middle of the night. I understand beds have to be freed up.

"You wouldn't be in hospital if you weren't unwell. I'm sure everyone wants to be discharged and go home but it's about making sure it's an appropriate time and everything in place.

"Clearly it would add to anxiety if suddenly you have got to get out and go."

Hospital bosses say all efforts are made to ensure patients go home at appropriate times after it was revealed thousands had been sent home in the middle of the night over the last two years.

The Royal Wolverhampton NHS Trust, which runs New Cross Hospital, said it "would not discharge a patient without a package of care in place".

A trust spokeswoman said: "Out of the 10,682 discharges occurring between 10pm and 6am over half of these - 57 per cent - were from our emergency department who were seen and treated in the department and did not need to be admitted.

"A total of 35 per cent of the discharges are maternity discharges from patients who do not need to be kept in for observation.

"We would not discharge a patient without a package of care in place. Some patients are discharged in the evening if they are fit and healthy to go home and have the support to be discharged."

Tom Jackson, director of finance at the Dudley Group NHS Trust, which runs Russells Hall, said: "Each patient is individually assessed before being discharged and will only be discharged if medically fit. The majority of patients - 97 per cent - are discharged before 10pm and 74 per cent are discharged between midday and 8pm.

"We discharge an average of four patients - three per cent - a night between 10pm and 6am. Out of this total, 1,000 discharges are from the Maternity Unit where new mums are keen to go home as soon as they can. Other discharges include end of life patients who choose to go home to be with their loved ones.

"Some discharges after 10pm may be due to availability of patient transport. In these circumstances, patients may be given the option of waiting until the following day before leaving hospital."

A UHNM spokesman said: “The majority of our patients requiring care in a community setting are transferred during the day but on rare occasions a patient’s consultant may decide that it is necessary, and in the patient’s best interest, to transfer them during the evening. These types of transfers are kept to an absolute minimum.

“Discharges across our hospitals include departments other than wards such as our emergency department, ambulatory emergency care, acute medical unit and the surgical assessment unit.”