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Hospitals sending home sick, vulnerable patients

Poor discharge practices leave sick, confused and scared people alone at home overnight

Louise Prime

Wednesday, 11 May 2016

Poor hospital discharge practice means that confused, scared and vulnerable people are being left at home alone overnight, with “devastating consequences”, the Parliamentary and Health Service Ombudsman reported this morning. It found many cases in which people, often elderly, suffered harrowing ordeals as they were discharged from hospital before they were fit to leave, or without making sure than they could cope on their return home.

The Ombudsman investigated four types of problems: hospitals discharging patients who are not clinically ready; discharging patients without properly assessing or consulting them; discharging patients without informing relatives and carers; and either discharging patients with no home-care plan in place or, conversely, not discharging patients because of poor coordination across services. It concluded: “Our casework on hospital discharge illustrates how failures in communication, assessment and service co-ordination are compromising patient safety and dignity, undermining patients’ human rights and causing avoidable distress and anguish for their families and carers.”

The Ombudsman said it found three key areas that warranted particular attention:

  • Failures to check people’s mental capacity and offer legal protections for those who lack capacity. The Ombudsman said it is “deeply worrying that hospitals are not recognising when they are depriving people of their liberty”.
  • Carers and relatives not being treated as partners in discharge planning. The Ombudsman said: “Families and carers often play an important role in their loved one’s recovery process. It is therefore vital that hospitals treat them as partners throughout the discharge planning process and don’t treat their involvement as an afterthought.”
  • Poor co-ordination within and between services, which has led to delayed transfers of care, poor or absent care and emergency readmissions.

Ombudsman Julie Mellor said: “Our investigations have found that some of the most vulnerable patients, including frail and older people, are enduring harrowing ordeals when they leave hospital.

“Poor planning, coordination and communication between hospital staff and between health and social care services are failing patients, compromising their safety and dignity.”

The Ombudsman’s report called on health and social care leaders to work harder to uncover why their failure to follow ten years of guidance to prevent unsafe discharge is leading to misery and distress for patients, families and carers.

Age UK’s charity director Caroline Abrahams commented: “This report and the dreadful cases it describes mark a new low in what looks like a continuous downward trend in the capacity of our health and care system to look after our older people adequately – indeed, on occasion even in its ability to keep the most vulnerable safe and alive.”

She added: “Good practice is about much more than just money but it is surely no coincidence that the position is getting worse at a time when the NHS is under appalling financial pressure and the social care system is falling apart at the seams.”

The NHS Confederation acknowledged that the Ombudsman’s findings were unacceptable and said they should trigger public debate about appropriate, safe and dignified discharge. But it also pointed to the incredible difficulties that health and social care services are facing as demand is increasingly outstripping resources. Its deputy director Phil McCarvill said: “Underfunded social care services continue to put immense pressure on NHS services and hamper efforts to improve care. This must be addressed by the Government.”

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