Evaluation into ‘Red Bag’ Hospital Transfer Pathway

Key learnings for Red Bag emergency transfer pathway revealed in report

The ‘Red Bag’ Hospital Transfer Pathway, which was highlighted in the recent NHS Long Term Plan, is now running across south London. But how effective is it? The HIN has produced this evaluation report which explores the impact and stakeholder experiences of implementing the pathway within three south London boroughs.

A new evaluation report has found that vital communication between paramedic crews, care home staff and hospital clinicians has been improved by the Red Bag Pathway when all measures were adhered to, but there are still a series of barriers to best practice to overcome.

The study, which included survey responses, interviews with hospital clinicians and paramedics, and a focus group with care home managers, found that the majority of care homes are using the Red Bag as intended. Conducted by the Health Innovation Network, the report said that improvements need to be made at both ends of the pathway to ensure it is adhered to and the benefits are fully realised.

Pioneered by Sutton Homes of Care Vanguard, the pathway ensures vital medical information, such as current medical condition and medicines regime, travels with the care home resident in a specially-designed red bag when they make emergency hospital visits.

Over two-thirds of the 90 survey responses from care homes, ambulance crews and hospital clinicians in Kingston, Richmond and Lambeth, stated that the Red Bag had improved communication between care homes and hospitals and made the handover to ambulance crews smoother.

Over half of care home managers believed the pathway had improved the transfer process for residents and both ambulance and hospital staff stated that the two forms most helpful in the Red Bag documentation were the ‘Do Not Attempt Resuscitation’ form, for older people making decisions about what happens towards the end of their life and the Alzheimer’s Society’s ‘This Is Me’ form to help healthcare professionals know more about people living with dementia.

As well as highlighting some of the positive effects the pathway has had on emergency hospitals for care home residents, the study also flags some of the challenges faced in implementing the transfer pathway. These included finding that, on some occasions, standardised patient information was either missing or incomplete when residents were transferred to hospital, that medical discharge information was not always sent with the patient and that locating and retrieving bags that had become lost in hospital transfers was particularly difficult.

Responses also indicated that both care homes and hospitals faced challenges with successfully promoting the pathway in the face of high turnover of staff and during the busy winter period. The report found that when the pathway was not adhered to – either in the care home or hospital setting – this caused practical difficulties and could result in despondency and frustration amongst professionals

The challenges highlighted have led to some wider learnings for practitioners. Don Shenker, who led the Red Bag project for the HIN, believes there are five key tips that can be taken away from the study:
1. When preparing the Red Bag in the care home, double check all the documentation is filled in properly
2. When receiving the Red Bag in the ambulance or hospital, read through the documentation
3. When transferring patients to different wards in hospital, check the Red Bag and documentation is with the patient
4. When discharging the resident back to the care home, make sure the Red Bag and discharge documentation accompanies the resident
5. When receiving the resident back in the home, update the care plan records.

Effective implementation of the Red Bag Pathway will contribute toward the Enhanced Health in Care Homes (EHCH) model as set out in the recent NHS Long Term Plan.

The report launched at a HIN sharing event, attended by staff from all parts of the Pathway, designed to ensure the complexities of implementing the pathway and opportunities for improvement are discussed more widely so all parties can work together to keep improving the use of the Red Bag.

Zoe Lelliott, Deputy Chief Executive for the Health Innovation Network, said:
“Our work is all about promoting innovation in the NHS and across the whole care system. The Red Bag is a successful innovation born in Sutton and recently extended across the whole of south London, but this study shows that there are still challenges and a focus on careful implementation is needed to maximise the benefits.
“True joined up work with our members and partners in south London is making a real difference to people’s lives and I want to thank all the health and care staff who have worked so hard to adopt the Red Bag Pathway in their areas.”

Berenice Constable, Head of Nursing for Kingston Hospital NHS Foundation Trust, said:
“Frail care home residents are at their most vulnerable when transferred in an emergency to hospital. It’s vital that the latest state of their health is communicated to all clinicians from ambulance crews to hospital staff so quicker decisions can be made over their care.
“It’s also a moment when they might lose important personal possessions from hearing aids to glasses, so the Red Bag Pathway is a simple innovation that, when followed fully, ensures the safest possible transfer as well as the fastest discharge.”
“This report shows that the Red Bag is really making a difference and improving the care of some of our most vulnerable residents.”

Evaluation of the Hospital Transfer ‘Red Bag’ Pathway in South London

Download the report here.

Thousands of care home residents across south London to benefit from safer emergency hospital visits and faster discharge as novel ‘Red Bag’ scheme expands

Innovative Red Bag

Thousands of care home residents across south London to benefit from safer emergency hospital visits as novel ‘Red Bag’ scheme expands

Novel ‘Red Bag’ ensures thousands care home residents across south London will have safer emergency hospital visits and faster discharge

The ‘Red Bag’ keeps vital medical info and personal belongings safe during emergency hospital visits

Thousands of care home residents will benefit from an innovation designed to make emergency hospital visits safer and speed up discharge after health and care chiefs agreed to extend the innovative Red Bag scheme across the whole of south London.

The news comes on the United Nation’s International Day of Older Persons (1st October) and means older residents enjoy a more personal and seamless health and care service.

Started three years ago Sutton Vanguard’s Hospital Transfer Pathway ‘Red Bag’ ensures key info such as existing medical conditions and other clinical information is communicated and helps ensure residents return to their care home as promptly as possible once hospital treatment is completed.

Developed by NHS and care home staff, the Red Bag has already been adopted across 11 London boroughs and is expected to go live in south London borough Croydon in November. NHS England unveiled a Red Bag scheme toolkit in June to encourage all areas of the country to adopt the scheme.

Care homes across south London, holding more than 13,000 care home beds between them, have committed to taking part in the Red Bag – a simple innovation which ensures records and personal belongings are kept safe when a care home resident is transferred into hospital.

Under the scheme, when a patient is taken into hospital in an emergency they have a Red Bag to take with them. The Red Bag contains:

  •  General health information, including on any existing medical conditions
  •  Medication information so ambulance and hospital staff know immediately what medication they are taking
  •      Personal belongings (such as clothes for day of discharge, glasses, hearing aid, dentures or other items)

The Red Bag also clearly identifies a patient as being a care home resident and provides hospital staff with the information they need to speed up clinical decisions. This means patients can often be discharged sooner which is better both for the residents and for the NHS, as it means individuals are out of hospital more quickly and money is saved. Extended hospital time can be particularly problematic for those with dementia who can deteriorate more rapidly when away from their usual settings.

The bag stays with the patient whilst they are in hospital. When patients are ready to go home, a copy of their discharge summary (which details every aspect of the care they received in hospital) will be placed in the Red Bag so that care home staff have access to this important information when their residents arrive back home.

The Red Bag has been used with care home residents 2,000 times in south London since April 2017 and length of stay in hospital has reduced by on average 2.4 bed days per Red Bag used.

The Red Bag initiative was created by Sutton CCG hosted Sutton Homes of Care, which was a national Vanguard programme to improve care in residential and nursing homes, in partnership with clinicians from Epsom and St Helier University hospitals, Sutton and Merton Community Services, London Ambulance Service and representatives of the care homes.

Since its introduction in Sutton, the Red Bag has also stopped patients losing personal items such as dentures, glasses and hearing aids worth £290,000 in a year.

There are half a million more people aged over 75 than there were in 2010 – and there will be two million more in ten years’ time. They are also spending more years in ill-health than ever before.

Caroline Dinenage, Care Minister, said:

“The Red Bag is a great innovation that helps link up health and care services for older people, so it’s fantastic news that the whole of south London is now committed to using it. Not only is this more efficient – saving valuable resources – but it leads to a much better experience for patients leaving hospital when their treatment has finished. It’s encouraging to see the scheme being rolled out even further across the country as we move towards our ambition of joined up care that is centred around the individual.”

Aditee Naik, Peartree Care Home Manager, said: “Care home residents are at their most vulnerable when they travel in an emergency into hospital. This is why the Red Bag is so important because it ensures all key paperwork, medication and personal items like glasses, slippers and dentures, are handed to ambulance crews by carers and travel with patients to hospital where they are then handed to the doctor.

“Sometimes it’s the personal touch that makes a big difference to patients, especially if they’re elderly, and the Red Bag helps people feel reassured and more at home. It’s great that on United Nations International Day of Older Persons, here across the whole of South London we are celebrating the fact that the Red Bag is helping ensure our older residents and patients have the very best care.”

Jason Morris, London Ambulance Service Clinical Team Leader, who helped develop the Red Bag at Sutton CCG during its national Vanguard status, said:

“The Red Bag standardises the process of handover from a care home and means we can get all the essential information in one go, no matter which home in they’re in.

“We’re delighted this scheme has led to such a wide range of benefits for us, our colleagues in hospitals as well as care home staff. But most importantly, it’s seen improvements in the care of these patients who can go to the hospital with everything they need. We’re even seeing them returning back to the care home quicker.”

Stephanie Watts, NHS Greenwich CCG Commissioning Manager, said: “The Red Bag pathway is a true example of collaboration between health and care agencies. It works well because all the agencies involved in patient transfers from care homes are invested in it.

“Use of the Red Bags has a number of proven benefits which we are already beginning to see, even though it’s only been a few months, including things like increased communication between hospital teams and Care Home staff, shorter stays in hospital and improved quality of information provided to Care Homes when their residents are discharged.”


Chris Terrahe, Deputy Director of Nursing at Croydon Health Services NHS Trust, said: “We are delighted to be working alongside our partners in Croydon CCG and local care homes as part of the new Red Bag scheme in the borough. For care home residents arriving at or leaving hospital, it should make things much more efficient because all the vital information about their health will be in one place.”


Dr Agnelo Fernandes, Clinical Chair of NHS Croydon CCG and local GP said: “I’m delighted that the Red Bag is being rolled out in Croydon.  We’ve seen that it can really reduce hospital stays for care home residents, ultimately improving their quality of life.”


Sarah Blow, Senior Responsible Officer for South West London Health and Care Partnership, said: “We’re incredibly proud of the work being done to improve the health of older people in Sutton by bringing together health and social care providers. Having seen the benefits to patients, we have already rolled out the red bag scheme in other boroughs in south west London, so we’re delighted that this will become a national scheme.”


Tara Donnelly, Chief Executive of the Health Innovation Network, said: “Our hospitals provide great care, but no one wants to spend any longer there than they need to and being transferred from a care home to hospital in an emergency can feel traumatic. That’s why the Red Bag is a great example of a simple idea with a big impact.”