- New report by Healthwatch England reveals stories of over 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 everyone looks beyond the artificial boundaries of their particular service and takes responsibility for ensuring people get home safely – 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 stories and pieces of evidence, gathered by 101 local Healthwatch from across the country, 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 organisations 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 2014 the NAO reported that in the space of a year the NHS deals with one million emergency readmissions within 30 days of discharge, costing an estimated £2.4 billion. Whilst not all of these cases are the result of a poorly managed discharge, Healthwatch England’s patient-led investigation found that 17 per cent of those being readmitted for the same issue in the past three years are returning to hospital within just seven days, suggesting a significant problem with the current process. (Those readmitted within a month account for an additional 9% of readmissions).**
Whilst not all of these cases are the result of a poorly managed discharge, Healthwatch England’s patient-led investigation found that 17 per cent those being readmitted for the same issue are returning to hospital within just seven days, suggesting a significant problem with current processes. (Those readmitted within a month account for 1 in 4 readmissions).** This is by no means a new problem, but this report highlights the human consequence of unsafe discharge and outlines the potential for saving millions of pounds by getting discharge right first time. The report describes some excellent examples of discharge being managed well, proving that the challenges of working across service boundaries can be resolved. But there is considerable variation up and down the country and a need for the good practice to be spread.
Healthwatch England’s call to everyone in health and social care is to not just hear what these 3,000 plus voices have to say, but to take action and devise a collective plan to tackle this issue and track progress. A first step was taken late last week when Healthwatch England and the Department of Health brought together all those organisations with an interest in getting this right in the future. Healthwatch England will be working with local Healthwatch to ensure the discharge process is put at the top of agenda locally as services work towards greater integration.
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 ways 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 on-going 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 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.
EXAMPLES WHERE THE SYSTEM IS GETTING IT RIGHT:
Care Navigators – For those with mental health conditions:
People in Waltham Forest are supported when discharged from specialist mental health services by a designated navigator for 12-18 months. They ensure that they have and attend appointments with GPs and practice nurses to monitor their mental and physical health and discuss the impact of their treatment. Navigators support people to reduce their dependency on services and address any social isolation they may be experiencing. By building relationships, they are able to identify early signs of mental health crisis and help prevent relapse. If someone does enter a period of crisis they receive increased contact with their navigator who can arrange referral, urgent out-patient appointments and development of a recovery plan. Outcomes of the pilot showed an overall reduction in crises where regular contact with the navigator is maintained. There have also been reductions in the duration of crisis episodes and the time spent by individuals in secondary care.
Kings Health Partners Pathway Project – For homeless people:
The Kings Health Partners Pathway has been operating across Guy’s and St Thomas’ and Kings Hospitals since January 2014. The team aims to improve the quality of care for homeless patients, reduce delayed or premature discharges, as well as future unscheduled admissions and A&E attendance. The team provides advice about homelessness, health, and housing law and supports people by providing a wide range of practical support and assistance including TV cards, clothing and canteen tokens. The team works with a patient to conduct detailed diagnoses of all medical problems and address their homelessness by liaising with local authorities and other agencies and acting as advocates for the patient at Homeless Persons Units. The team works to ensure health and social care needs are met in the community and safely reconnects people to their area of origin when appropriate. The Pathway project started with one team in University College Hospital London and the approach has now spread with teams of different varieties now working in 11 acute trusts across the country. The Pathway Approach has shown a 30% reduction in annual bed days for homeless patient admissions.
My Discharge Project at the Royal Free Hospital – For older people with dementia:
Dementia patients are assessed for discharge within 24 hours of referral to build understanding of their needs and ensure that their departure from hospital will be safe. Patients are also provided with intense therapy and a single point of contact is available to people and their carers. The project also helps family members prepare for coping with a dementia patient once they return home. When patients are discharged, they leave with a discharge letter and emergency phone numbers and are accompanied home with food and clothes if needed. The team will also liaise with social care colleagues and voluntary sector organisations to get care visits set up and equipment in place. This service helps people with dementia to stay in their homes after discharge, reduces readmission and discharge to nursing homes and supports family members to care for their partners in their own home.
Anna Bradley, Chair of Healthwatch England, said: “Throughout the inquiry we have heard thousands of shocking stories about what happens when people leave hospital without the right planning and support. This is not a new problem, but what makes these findings worse, is that in many cases some pretty basic things could have made all the difference. “There is a huge human and financial cost of getting discharge wrong. We hope that the increased focus on integration of health and social care, and pressure on finances will create a new impetus to fix it. “Whether it is about properly helping new mums at risk with depression or making sure patients receiving end of life care are given the support they need to spend their final days at home with their loved ones rather than in hospital, everyone should experience a safe, dignified and well planned transfer of care. “In some places this is done really well, but the good practice that exists is not being spread. To 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.”