TENS OF THOUSANDS OF HOSPITAL READMISSIONS NATIONALLY COULD BE AVOIDED WITH GREATER FOCUS ON RECUPERATION AND RECOVERY, SAYS PATIENT WATCHDOG
- New national report reveals stories of 3,000 people from vulnerable groups and their experiences of the discharge process.
- Five key problems identified including poor communication and coordination between services and people not being involved in planning their discharge.
- Discharge process at its best when NHS managers, clinicians and care workers look beyond the artificial boundaries between services and take responsibility for ensuring everyone gets home safely and have the support they need – preventing unnecessary suffering and saving the tax payer millions.
A new report launched today (21 July) – ‘Safely Home: What happens when people leave hospitals and care settings?’– brings together 3,230 patient stories and pieces of evidence gathered by 101 local Healthwatch from across the country including Healthwatch Cumbria, revealing both the human and financial cost of getting the discharge process wrong. The report identifies a number of common basic failings including hospitals not routinely asking patients if they have a home or safe place to be discharged to, details of new medications not being passed on to GPs and carers and families not being notified when loved ones are discharged. Many of the problems stem from institutions and professionals failing to think beyond their own direct responsibilities, with discharge plans often not considering patients’ other clinical needs or home environment, including whether or not patients themselves have carer responsibilities.
In 2012-13 there were one million emergency readmission within 30 days of discharge, costing the NHS and estimated £2.4 billion a year in additional immediate treatment costs and the ongoing medical and care needs of those affected. Whilst not all of these cases are the result of a poorly managed discharge, Healthwatch England’s patient-led investigation into people’s experiences of the discharge process found that as many as two thirds of those being readmitted for the same issues are returning to hospital within just 7 days of having been sent home.
This is by no means a new problem, but this report is the first real attempt to highlight how widespread this problem is, the level of unnecessary suffering that is happening as a result and to outline the potential for saving millions of pounds by getting discharge right first time.
Armed with this new insight, the Healthwatch Network is now working with the Department of Health to secure a commitment from national players like NHS England, right down to every hospital manager, ward nurse and care worker to ensure the NHS and social care services do whatever they have to do to ensure people get home safely.
FIVE AREAS WHERE THE HEALTH AND SOCIAL CARE SYSTEM IS GETTING DISCHARGE WRONG: Focusing on those most affected by poorly managed discharge processes – those with mental health conditions, older people and homeless people – the report reveals five key themes of how patients and care users say they are currently being let down by the system:
- People are experiencing unsafe, delayed or untimely discharge due to a lack of co-ordination between health, social care and community services. A young mother was kept in hospital and away from her daughter extensively because an agreement could not be reached between health and social care services on the funding of her care.
- There is a lack of support available for people after discharge, often leading to readmission. An 81-year-old man who had suffered his third, severe stroke was discharged from hospital at 10:30pm by taxi, without anyone from his family being notified. He was readmitted with severe health problems the following week.
- Many people feel discriminated against or stigmatised during their care, often feeling ‘rushed out the door’. A homeless man reported that he felt that the perceptions of staff regarding his homelessness meant he was repeatedly discharged as quickly as possible, ending up back on the street with persistent health problems and no support for his recovery.
- People do not feel involved in decisions about their ongoing care post discharge. One woman told of the shocking story of her husband being discharged after a suicide attempt, despite his repeated pleas to stay because he did not feel able to cope. No follow up care was offered upon discharge; he committed suicide the following week.
- Individuals’ full range of needs are not considered when being discharged from hospital or a mental health setting – including their housing situation, carer responsibilities etc. One woman, a carer for her husband, told how she was discharged with no care plan for herself and no additional support to help with care for her husband who has Alzheimer’s.
WHAT PEOPLE SAID THEY WANT WHEN THEY ARE DISCHARGED FROM A HOSPITAL OR CARE SETTING:
- To be treated with dignity, compassion and respect.
- For their needs and circumstances to be considered as a whole – not just their presenting symptoms.
- To be involved in decisions about their treatment and discharge.
- To move smoothly from hospital to onward support available in the community.
- To be properly informed about where to go for help after discharge.
Anna Bradley, Chair of Healthwatch England, said: “Ensuring people get home safely from hospital is about involving patients and their families in the planning process, treating them with dignity and ensuring the right care networks are put in place before they leave. These basic principles should apply to everyone, whether they need help recovering after a bad car accident or the right support to spend their final days at home with their loved ones rather than in a hospital.
“In some places this is done really well, but health and social care services have struggled to apply these approaches everywhere and continue to fail patients in their duty to get everyone home safely. “Replicating the good examples is a start, but to truly change people’s experiences we need everyone across health and social care to commit to putting the needs of individuals at the heart of the discharge process, ensuring that patients’ discharge plans are right for them and their specific recovery needs.
“Led by those who have been directly affected as a result of an unsafe discharge, this inquiry starts to set out for the first time the sheer scale of this problem, the suffering it is causing on a daily basis and the financial consequences. Its findings cannot be ignored. “This is a long standing problem, but the increased focus on integration and efficiency across health and social care means now is the time to fix it. This would mean better experiences for people and help the NHS save money.”
‘Safely home: What happens when people leave hospitals and care settings?’ published Tuesday 21 July, contains the findings of a yearlong Special Inquiry by Healthwatch England into unsafe discharge. The report is compiled from evidence gathered by 101 local Healthwatch and stories collected from over 3,000 people across England on their experiences of the discharge process, focusing particularly on people with mental health conditions, older people and homeless people.
A full copy of the report is available at :
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