Patients suffering due to poor hospital discharge procedures

HOSPITALS are discharging vulnerable patients without first checking they have the necessary social care support in place, according to a new report from Healthwatch England.

Nearly a fifth of patients discharged in the last three years felt they did not have the support they needed after leaving hospital, while an additional 26 per cent said this problem had affected a friend or relative. One in eight patients felt unable to cope at home, leading many to be readmitted.

The Healthwatch England report Safely home: what happens when people leave hospital and care settings? brings together stories and evidence from more than 3,000 people across the country who were older, homeless or had mental health problems.

The aim was to highlight both the financial and human cost of poor discharge practice.

Figures revealed one in eight patients felt unable to cope in their home following a hospital stay, leading many to be readmitted. In 2012-2013 alone there were more than one million emergency readmissions within 30 days of discharge, costing an estimated £2.4 billion.

The report identified several common basic failings contributing to poor practice. These include hospitals not routinely asking patients if they have a home or safe place to be discharged to details of medications not being passed on to GPs and carers, and families not being notified when loved ones are discharged.

People often experienced delays and a lack of coordination between different services or did not feel involved/informed in decisions about their care. Many felt their full range of needs was not considered, while others felt stigmatised and not treated with respect.

Often people reported that, while they were deemed medically safe to leave hospital, they did not feel safe or adequately supported to do so. This included one man who had received hospital treatment for severe depression and anxiety. He did not want to return home but was discharged, only to commit suicide the following week.

Others highlighted problems with being kept in hospital too long, with many waiting for medication to be signed off, or for social care arrangements to be made.

Healthwatch England chair Anna Bradley said: “When we started this inquiry, we knew this issue affected thousands of people across the country. But it was still shocking to hear the sometimes tragic consequences of what people had been through. Even more so when often just a simple thing could have made all the difference.”

She said many examples of good practice had been found but “unfortunately this good practice is simply not widespread enough to resolve the issues.”

She said Healthwatch England were working with the Department of Health to tackle the issue, adding: “[T]o truly change people’s experiences, we need a system wide commitment to putting their needs at the heart of processes.”

Health watchdog NICE said many discharge problems could be avoided if recommendations from their guidance on service user experience were more regularly put into practice.

They advised that discharges should be structured and phased, ensuring arrangements are discussed and planned carefully beforehand with the patient. Care plans should support “effective collaboration” with social care and other care providers, they said, including details of how to access services in times of crisis. Patients should also be properly supported when they are referred to other services, with arrangements for support agreed with them beforehand.

Read the full Healthwatch England report.