Unsafe hospital discharge of older patients ‘getting worse’
CEO of the older people's charity Independent Age, Janet Morrison says poor discharge practice is a symptom of an under-funded NHS.
Failures to discharge patients safely and appropriately costs the NHS hundreds of millions a year and is putting the health and well-being of patients at risk. And the situation is getting worse.
Later today, I will appear before the Public Accounts Committee to give evidence to their inquiry into the discharge of older people from hospitals. I’m delighted MPs are giving this urgent issue the scrutiny it deserves.
As an older people’s charity, we regularly hear from older people who have been discharged inappropriately due to pressure on hospitals, or have been stuck in hospital due to a lack of social care support in the community.
Of course, poor discharge practice affects patients in all age groups. But it is older people who bear the biggest burden: the National Audit Offices estimates that 85% of people affected by delayed discharge from hospital are over the age of 65, for example. And, according to Healthwatch England, between 2005 and 2015, emergency readmission for those aged 75 and over increased by a shocking 88%.
Take Mr Thompson[1], just one of the many cases we come across. Mr Thompson is in his eighties, and recently went into hospital with significant health problems including dementia and cancer. He was told that he would need to move into a care home once he was discharged, and that he qualified for local authority care. But an ongoing dispute between the NHS and the local authority meant that no home would take him. In total, he was in hospital for six months, and his family have said his extended stay has been seriously detrimental to Mr Thompson’s welling.
The individual cases we hear about from our work supporting older people and their families are tragic in their own right. But they are also a sign of a wider health service under severe strain and social care services cut to the bone.
Most of us are rightly proud of our world class NHS, but ever growing demand is increasing the pressure on already stretched hospitals. Higher bed occupancy rates and growing waiting times means there is a greater pressure to get people out of the system quicker.
And a lack of social care in the community often means frail and elderly people stuck in hospital beds, not because they are sick but because there isn’t the support at home to discharge them.
Last year, three quarters of a million hospital beds days were lost in England because otherwise healthy patients were waiting for a home care package or a place in a residential or nursing home. In these situations, it is the NHS that picks up the bill for a failure to invest in social care.
There is undoubtedly more than hospital could do. For example, we think more could be done to ensure patients and their families get the right information and advice, so they can make the right decision about their care. And hospitals need to make sure they are better integrated with local care services, and both parties are putting older people at the centre of decision making.
But ultimately, the NHS can only do so much on its own. Our society is only getting older, and we urgently need the Government to confront the issue of the future of health and social care funding head on. That is why we support calls for the Government to establish a cross-party, independent commission into the future of the NHS and social care in England.
[1] Name changed for purpose of this article
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