A new briefing launched today – ‘What happens when people leave hospital and other care settings?’ – outlines where important steps have been made towards improving the discharge process for patients.
However, the 2,083 people’s stories used to compile the findings also continue to show significant variation. This highlights the need for good practice to be spread and properly evaluated to ensure it is having the right impact.
In 2015 Healthwatch England’s ‘Safely Home’ inquiry helped to galvanize system-wide leadership to tackle the underlying problems of transferring patients between services. Yet it is clear from NHS statistics, such as the numbers of delayed transfers of care hitting record levels, that the challenge is still growing.
This new briefing looks at what 46 local Healthwatch heard about people’s experiences of the discharge process since 2015.
Key findings include:
- People still don’t feel involved in decisions or that they have not been given the information they need, including advice on possible side effects of new medications or who to call for advice out of hours
- People continue to experience delays and a lack of co-ordination between services, highlighting specific problems with hospital pharmacy services, patient transport, and care homes or family members not being notified when people are about to be discharged
- People feel left without the services and support they need after leaving hospital, with discharge plans not considering patients’ other clinical needs or home environment, including whether or not patients have carer responsibilities
Healthwatch Rochdale case study
“One elderly patient was discharged from North Manchester General Hospital back to their residential home in the Rochdale borough around mid-afternoon. Residential staff had already been informed that the patient had a catheter in situ, however when the patient arrived home they did not have any day/night catheter bags and there were no straps on the catheter bag they were wearing at the time. The Senior Care Assistant asked the ambulance transport staff if the hospital had sent any supplies but they replied no”.
One person speaking with Healthwatch Windsor, Ascot and Maidenhead about their experience as a patient said:
“Discharged without support, with low blood pressure, very weak and unsteady on my feet and diarrhoea, told to take a walking frame to get around, no question of an assessment regarding the layout of my home and how I was going to be able to get upstairs…which I can’t so have to sleep on the sofa….very angry”
A relative speaking with Healthwatch Hillingdon said about her mum’s experience:
“Mum was given the Friday as a discharge date. I arranged with the hospital that she would be brought home in the hospital transport ambulance at 4pm as I had arranged for two carers to receive her at her house. This was necessary as Mum cannot walk, is very deaf, diabetic and needs support.
“For some reason the hospital transport ignored this instruction and took her home at 2pm. They took the key out of her key safe and let themselves in, dumping my Mum on the bed. They left her alone without a drink or any support.”
Improvement case study
Healthwatch Kent found that a third of those they spoke with said they didn’t feel involved or listened to during their discharge from hospital.
Following the Healthwatch report, the local hospital trust introduced a series of measures to ensure staff are better equipped to provide support, including arranging for hospital staff to visit local care homes and other community based services.
There has also been significant focus on encouraging patients to ask questions about their discharge plan to help them understand the full range of options available to help people with their recuperation.
Healthwatch is calling for a fuller understanding of what’s happening in local areas, with local leaders urged to use the experiences of the people behind the delayed transfers of care statistics to identify where improvements can be made.
The new Healthwatch briefing highlights a number of approaches that are already helping to reduce delays getting people out of hospital, such as ‘Discharge to Assess’ and ‘Red2Green’. However, wherever they are introduced, new programmes must be evaluated to ensure they are having the right impact, and that people are getting home safely and efficiently.
Kate Jones, Chief Executive Officer of Healthwatch Rochdale, said:
“We have heard from local Residential and Care home staff about patients being unsafely discharged from hospital. Rochdale residents have asked us to look at Pennine Acute Hospitals NHS Trust as part of our work for 2017/18 and the hospital discharge process forms part of this. We are asking patients in the Rochdale borough to share their experiences with us so that together we can help to make the discharge process better for you, your family and friends”
Imelda Redmond, National Director of Healthwatch England, said:
“Getting people out of hospital and safely home is not about a single point in time. It is an ongoing process that requires thought, planning and support before, during and after the moment someone is actually discharged. Things work best when staff in all services work together to provide a seamless experience.
“Whilst we heard plenty of positive stories from people moving between hospitals, care homes and their own homes, the number of people stuck in hospital waiting to leave has increased significantly. From what people tell us, it is clear many of the common problems around communication and coordination are still ongoing.
Healthwatch will continue to play our part, working with hospitals, community services and the public to improve people’s experiences.”