Unsafe discharges from hospital are putting lives at risk
3 min read
Ahead of her oral question on the matter, Liberal Democrat peer Baroness Walmsley says more could be done to address the poor discharge practises of England's hospitals.
Complaints about problems with discharge from hospital have risen this year. A recent report from the Health Service Ombudsman paints a horrifying picture of the experiences of some frail elderly and vulnerable people. I think we are all aware of the fact that many such people are having to stay in hospital, taking up beds that could be used for others, long after they do not have a medical need to stay there. However, it is vital that proper arrangements are made for them to go home when the time is right. Their family need either to take them home or know they are coming so they can be there. An appropriate package of care and support must be in place to ensure they can manage at home with dignity and comfort. But here’s the rub! The crisis in social care is making it very difficult for local authorities to provide it and pay for it and for hospitals to arrange it. Some do a magnificent job but others are failing their patients.
Whenever this matter is raised the Government tells us about the Better Care Fund and the precept which local authorities are now allowed to raise for social care. There are two problems with that. First of all, this year more of the Better Care Fund is going to the health service than to social care. Secondly, the precept will not raise enough money and will raise least in areas where it is needed most.
The Ombudsman, Dame Julie Mellor’s report uses case studies to illustrate the four key issues that arise from the many complaints she received. Most of them beggar belief. They not only describe the danger and discomfort in which patients themselves are left but also the anguish of their families. Some patients were even discharged before they were clinically ready to leave hospital. This is clearly a function of the enormous pressure on beds in some areas. Secondly some patients were not assessed or consulted properly before being sent home, alone, afraid and unable to cope. Even if their needs had been assessed on admission, this was not reviewed before they were sent home to ensure nothing had changed. Far too frequently relatives and carers were not told that their loved one was being discharged. It was highly distressing for them to find that they had not been there to help when their relative needed them. Finally, some patients were discharged without a proper home care plan in place. Lack of integration and poor joint working was blamed for this, as well as a shortage of provision. Even when provision is available, lack of coordination between health and social care services can cause lengthy delays in discharges and consequent “bed blocking”.
Sadly this situation does not seem to have improved much since Healthwatch published their shocking report Safely Home about a year ago. All the same problems were reported by the 3000 patients surveyed on that occasion. Many also reported that they felt stigmatised, discriminated against and not treated with proper respect because of their condition or circumstances. They were not involved in decisions on their care or given the information they needed.
The Ombudsman’s recommendations are threefold. First the mental capacity of the patient should be checked before discharge. Assumptions should not be made. Secondly, carers and relatives should be treated as partners in the process. Thirdly, the poor co-ordination could be improved if the new care models in the NHS Five Year Forward View were to be implemented everywhere. I hope that all NHS and care services will follow these recommendations in future.
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