NHS night-time discharges: questions raised about Times report
13th Apr 2012
This week, the Times reported on an 'NHS scandal' whereby patients were apparently being discharged from hospital in the middle of the night.
100 responses to Freedom of Information requests put out to all NHS Hospital Trusts revealed that 239,233 patients had been sent home between the hours of 11pm and 6am last year.
The Times went on to claim that "if all other trusts are discharging at similar rates, this would add up to more than 400,000 such discharges every year, almost 8,000 a week". Such figures might suggest to readers that many UK hospitals operating at full capacity are systematically turfing out patients after treatment on a nocturnal basis.
While a comprehensive national breakdown of the figures is hard to come by, the headline number is certainly supported by the details of one particular case study given to Full Fact, courtesy of BBC Health Correspondent Jane Dreaper.
In a document emailed to her from the University Hospitals of Leicester NHS Trust, 9,000 of the 132,000 patients discharged in 2011/12 were discharged between 11pm and 6am. This equates to 6.7 per cent of the total proportion of patients discharged, making Leicester the 4th 'worst offender' of the practice.
But there is more to this headline figure than first meets the eye, as it doesn't detail the reasons for patients' being discharged overnight.
In Leicester NHS Trust's response, some patients were discharged at night on account of being dead; others were self-discharged. This represents 1,200 of the 9,000 cases reported.
The Hospital Trust also note that their FoI response to the Times included maternity unit and admission/decision unit discharges - used as a short-stay ward for patients that may move on for treatment elsewhere, for example with a GP - "where it is appropriate to discharge patients on a 24hr basis". This accounts for a further 6,000 cases.
Once these categories are removed from the total, we are left with 1,800 patients defined as discharged between 11pm and 6am, which amounts to 1.5 per cent of all discharged patients. This brings Leicester's record closer to so-called better performing NHS Trusts such as Newcastle, who have a policy not to discharge patients at night.
But despite having "no centrally recorded instances of exceptions to this policy", even Newcastle Hospital Trust is reported to have had overnight discharge rates of under 1 per cent last year, which suggests that some patients do leave the hospital in the small hours under exceptional circumstances.
There is one final twist to the story that is not reflected in the Times's initial scoop. Leicester NHS Trust claims that the headline figures also fail to make a distinction between the recorded time of discharge and the actual time of discharge. They go on to argue:
"As such it is very likely that ward teams will, especially on busy days, discharge a patient at a reasonable time but only log the discharge later in the evening once the remaining ward patients are settled for the night".
This means that the time of a patient's discharge may depend upon when the appropriate member of the team's medical staff logs into onto the hospital's records database, and may not reflect the true time they actually left hospital.
This may be the most important caveat to have gone unreported in the Times's story, for what we do not — and may never — know is the extent to which this will affect the figures for patients discharged overnight. What little we do know, however, suggests that the rates of discharge for even the worst offenders in the NHS may not be as high as the Times reported.