Discharge from hospital - Phase 2: post-discharge

This report is the second phase of Healthwatch Cheshire East's Discharge from Hospital project. Phase 1 captured what patients experienced while still in hospital, at the point their discharge was being discussed or finalised. Phase 2 follows those same patients from the moment they left the hospital through to how they were settling into life at home or in a care setting weeks later. 

Between December 2025 and March 2026, Healthwatch contacted the 20 Cheshire East residents who had taken part in Phase 1. Thirteen agreed to a follow-up interview. Two had moved to end-of-life care since their hospital discharge, and five could not be reached despite repeated attempts. Of the 13 interviewed, seven had been discharged directly home and six to a care setting. Three of those six subsequently returned home during the course of the project, giving a fuller picture of the journey through all three routes. 

On the day of discharge itself, the practical mechanics — medication, transport, and the appropriateness of timing — were largely handled well. Eleven of the 13 patients felt the timing was right, and all 13 left with sufficient medication; ambulance and Red Cross crews were consistently praised. Waiting to actually leave was a different matter, though: for some patients this stretched from hours into days, and one patient waited over a week. 

What happened once patients left the hospital varied widely, and for some, it fell far short of what they needed — depending heavily on the setting they arrived in and what had been put in place for them. Eight of the 13 patients had no named point of contact after discharge — no number to call, no coordinator to reach if something went wrong. For some, a care home, care package, or family filled that gap. For others, no one did. 

Among those who went directly home, some had excellent care packages and felt well supported. Others struggled from the start. One patient was readmitted to hospital within days, diagnosed with pneumonia and blood clots; his family felt he had been discharged before he was medically fit. Another's family found themselves managing her care after finding the arranged package wholly inadequate — and ultimately arranged a care home placement themselves and paid for a private ambulance to move her, after being told the patient would "have to be dying" before the hospital would consider that option. 

Among those who went to care settings, experiences varied widely. Some patients felt genuinely well cared for, while others reported feeling isolated. They told us that their dietary needs were often overlooked, personal care was not provided, and there was little to no rehabilitation offered. For many, the decision to move to a care home felt imposed rather than mutually agreed upon. This theme was evident in Phase 1 and continued into Phase 2. 

Across all journeys, two themes were consistent: the gap in physiotherapy and rehabilitation follow-up, and the emotional weight of the transition, which the formal care system largely did not address.