Are hundreds of patients being 'thrown out' of hospital beds overnight?

The Times's front page this morning reported that NHS chiefs had failed to curb the "scandalous practice" of patients being discharged from hospital overnight.

The story originates from a series of freedom of information requests by Sky News purportedly sent to all 160 NHS acute trusts in England. 72 responded with full figures for the past three years.

Sky reported that more than 300,000 patients since 2012 were discharged late at night between 11pm and 6am (roughly the same as 400 per night). A similar investigation by the Times in 2012 sparked a government investigation with Medical Director Bruce Keogh stating at the time that people should only be sent home when it is "appropriate and safe".

It's undoubtedly a serious issue and the NHS itself condemns the practice where it's deemed 'inappropriate'. But the figures being quoted this morning, as with the same reports from 2012, don't show how many people are "thrown out" or "sent home", because they don't specify the reasons for discharge, which can include the patient self discharging themselves from hospital, or even patients who've died while in hospital.

NHS England itself disputes the figures, as does Dr Mark Temple of the Royal College of Physicians.

Strings attached to trusts' figures

We do know that fewer than half of English trusts responded to the request, so if anything the figures may be higher if more had responded. Then again, we don't know why there were so many missing figures.

Sky News hasn't provided us with a compilation of the responses they received, but we can look at recent requests on the same topic published by individual trusts, some of which may be in response to the Sky News research.

Looking at just a few, there's likely to be more to the findings. North Tees and Hartlepool foundation trust was asked for figures on overnight discharges earlier this year, over the same time periods suggested in the Sky News Story.

They were able to supply figures, but they included - among other things - discharges based on deaths and self discharges (where the patient chooses to leave). These cases clearly aren't examples of being 'thrown out'.

A more recent response from Royal Cornwall Hospitals trust also said that self discharges were included, but didn't say how many cases were involved.

As a final example, Ashford and St Peter's Hospitals foundation trust received the same request as Royal Cornwall, but conceded it couldn't even provide any data accurately:

"... we are unable to ascertain this information accurately from our Patient Administration System as this does not include an accurate time of discharge but instead the time at which the discharge was processed which is often many hours later or at night during the quieter hours on the ward."

Dr Mark Temple from the Royal College of Physicians echoed this point, commenting that "we need to know whether this is the time when patients are actually leaving hospital or whether it is when nurses are getting round to recording their discharge on the system"

We don't know for sure what Sky News actually asked in its research, but these responses aren't encouraging, and the broadcaster gave little further detail in its coverage.

The Times did make one concession after writing its article: their medical correspondent said that some discharges will have only involved patients admitted within the previous 24 hours, and it was to be expected that some patients would want to go home to their own bed anyway after treatment.

Either way, there's no way for us to tell from the Sky News research how many cases will be like this.

NHS England gave Full Fact their own briefing note on the story, detailing their view on the caveats. Among them it commented:

"It is absolutely right that discharging patients at night without appropriate support is unacceptable, particularly if a patient is vulnerable. This FOI data does not provide the level of context or detail to make that kind of conclusion - an in-depth investigation would be required."

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NHS England briefing note

1. It is not possible to conclude from this data that patients are being discharged inappropriately. It is therefore misleading to patients to state, on the basis of this information, that patients are being "chucked out" of hospital.
2. It doesn't reflect whether patients have self - discharged.
3. This data doesn't reflect whether a patient has been discharged during the day but that the discharge is logged at night when nurses have more time.
4. It doesn't reflect that many patients actually want to be discharged in the evening or in the morning to get back home, such as new mothers or someone who is admitted to hospital via A&E late at night and after a short observation is safe to return home. Where a patient wishes to leave late at night or early in the morning, it is right that this should be accommodated as long as it is safe and clinically appropriate and with the support of family, friends or carers.  The decision to do this should always be based on what is best for the patient.
5. We do not know the extent to which this FOI response was interpreted by Trusts on a consistent basis, enough to make a definitive comparison.
6. It is absolutely right that discharging patients at night without appropriate support is unacceptable, particularly if a patient is vulnerable. This FOI data does not provide the level of context or detail to make that kind of conclusion - an in-depth investigation would be required.