Hospital discharge (physical illness)

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Introduction

This section applies to discharge from hospital for a physical illness. For discharge from hospital for a mental illness see Hospital Discharge (mental illness).

What are clients entitled to?

  • In England, hospitals that provide inpatient care, urgent treatment centres, and emergency departments all have a duty to refer Clients to the local authority homelessness/housing options team of their choice where they are homeless/likely to become homeless within 56 days. If a hospital has a pathway established this will likely be within their own local authority area.
  • So long as the Client is eligible (a British national/has a permanent right to reside in the UK), the housing authority is then under a duty to take reasonable steps to prevent the Client from becoming homeless.
    • They should work with the Client to develop a personalised housing plan.
  • If the Client is homeless during the 56 days after discharge, and may have a priority need (e.g. because they are pregnant, have children in their care, or have some form of disability), the housing authority should provide them with temporary accommodation.
  • More broadly, hospitals have a duty to cooperate with local authorities to promote the well-being of adults with needs for care and support. Moreover, where the hospital considers that it is not likely to be safe to discharge the patient unless arrangements for meeting the patient’s needs for care and support are in place, the body has a duty to give notice to the local authority.
    • Clients who are homeless are likely to have needs which satisfy these criteria (see Care Act 2014 section for more detail)
  • Even if the Client is not a British national/does not have a permanent right to reside in the UK, Local councils are obliged to give everyone advice and information about homelessness, free of charge.

 

How can a Client make their case effectively?

Unsupported individuals

  • For those (rare) instances where a hospitalised Client is not already linked into support, the Client should make clear that they give consent for the referral to be made; and ideally should bring with them a completed Duty to refer: referral form.
  • Make sure if asked which local authority they wish to be referred to that they select one where they live/work/have a close family connection – as they will be owed more duties by local authorities where they can demonstrate they have a “local connection” with the area.
  • If possible, send the hospital a letter beforehand, explaining that the Client is at risk of becoming homeless and should not be discharged without St. Mungo’s first being contacted (see for example Appendix 1 – Hospital Discharge Letter Template)

Supported individuals

  • More commonly, it will be at this stage where the client should be supported to make a Homeless Application to the local authority.
    • For further information on making Homeless Applications see Part 7 Homeless Applications
  • The Client will likely also need a Care Act Assessment or an Assessment under the NHS and Community Care Act.
  • As regards presenting a case that someone has priority needs – this is a particularly complicated area where an experienced housing worker or homeless health GP might be better placed to advise.

What do you do if a Client is ignored/refused their rights?

  • If the Client has not been referred there is no sanction specified in the Legislation. However, there are a number of routes by which a Client could bring a legal claim where they have been discharged prematurely or unsafely:
    • Breach of statutory duty – Even if the statute does not deal with the matter expressly, the courts may decide that Parliament intended to individuals to be able to recover damages for breach of a statutory duty. In this case, this could be any of: the duty to refer, the duty to cooperate or the duty to give notice.
    • Professional/Medical Negligence – every medical professional owes a duty of care to their patients; and failure to comply with a statutory duty will almost certainly fall below the “reasonable” standard of care threshold. If this failure has caused the Client harm, they may be able to bring a claim for compensation – though this will depend on the specific facts of the individual’s case.
    • Judicial Review – As hospitals are public bodies their decisions can be challenged in court if they are irrational, illegal, procedurally unfair, or breach the Client’s Human Rights. Breach of the statutory duty potentially falls under the ground of “illegality”. These proceedings can result in compensation as well, but could also potentially cause the discharge to be halted or reversed. However, it is not an appeals process and cannot be used to challenge a decision that you simply do not agree with. Judicial Reviews also have strict time limits and procedural requirements which will likely necessitate professional legal advice.  
    • Professional Regulators – there are various Regulators in the medical sector including the General Medical Council (GMC), Health & Care Professions Council (HCPC) or Nursing and Midwifery Council (NMC). Threatening to report an incident to the relevant regulator may be enough make an individual practitioner take a Client’s concerns more seriously.
  • If you do not think a referral has been acted upon, in the first instance you should get in touch with the local housing authority.
  • If you want to complain about how a hospital discharge has been handled, speak to the staff involved to see if the problem can be resolved informally.
  • If this still does not resolve the issue, it may be necessary to raise a safeguarding concern regarding unsafe and/or unsatisfactory hospital discharge.
    • Agencies have a legal responsibility to raise safeguarding concerns where there is a suspicion that abuse of a vulnerable adult has occurred which may be as a result of neglect or omission of care. (see further Safeguarding section of toolkit for Safeguarding Adult Reviews)

What sources of expertise/clout can you turn to?

  • They also produce specific guidance for hospital teams on establishing ‘duty to refer’ protocols.
    • See in particular “Standards for secondary care services” and the appended referral form.
  • PALS can help resolve concerns or problems if you’re having difficulty with a particular hospital or trust; as well as providing information on the NHS complaints procedure.
  • If a Client has been discharged without a referral, Health Watch (03000 68 3000) can help you raise a complaint.
    • They can help you navigate the NHS complaints process or explain how to go about reporting the incident to the GMC, HCPC or NMC.
    • Citizen’s Advice also maintain a list of other organisations that can help you make a complaint or bring legal action (as necessary).
  • If a Client has been discharged without a referral, and this has led to significant further harm, Fieldfisher (one of St. Mungo’s corporate partners – 0800 358 3848) may be able to help you bring a claim for compensation or a Judicial Review.
    • They have a free online enquiry system which can help identify whether a Client is likely to have such a claim.

 

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