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21.07.15

Unsafe hospital discharges lead to fast readmission

Poorly managed hospital discharges are costing the NHS billions of pounds a year, aggravating the ill-health of patients and ultimately causing thousands of readmissions, according to a report by patient watchdog Healthwatch England.

The patient-led investigation found that 17% of patients being readmitted for the same issue are returning to hospital within just seven days.

In 2014, the National Audit Office found that the one million emergency readmissions costed the NHS an estimated £2.4bn a year.

Healthwatch England gathered 3,230 stories and pieces of evidence from patients across the country to reveal the financial and human cost of getting the discharge process wrong – either due to poor coordination between services, a general lack of post-care support, stigmatisation or lack of patient and family involvement in treatment and discharge decisions.

The year-long watchdog inquiry looked at 120 Freedom of Information responses from hospital trusts, finding that more than half fail to ask or record whether patients have a suitable place to be discharged to with access to food, water and heating.

One in three trusts do not make sure notes about new medications are recorded and passed on to GPs and carers. One in 10 checklists fail to make sure a friend, relative or carer is notified whenever a patient is discharged.

The final report, ‘Safely Home: What happens when people leave hospitals and care settings?’ was launched today (21 July).

As a first step to remediate this persistent issue, Healthwatch and the Department of Health brought together organisations interested in finding solutions for discharge processes last week. Healthwatch England will now be working with local Healthwatch to ensure this issue is prioritised in the agendas of different local services.

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. 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.”

The report established five main areas where the health and social care system is lacking in successful discharge processes.

These include people experiencing unsafe, delayed or untimely discharge due to a lack of coordination between health, social care and community services, as well as a lack of support available for people after discharge.

The investigation also found that many people feel discriminated against or stigmatised during their care and are therefore ‘rushed out the door’. They also do not feel involved in decisions about their ongoing care post-discharge.

Patients also claimed that their full range of needs is not considered when being discharged from hospital or a mental health institution such as their housing situation and carer responsibilities.

Ultimately all participants demanded being treated with dignity and respect and that their circumstances and needs be considered as a whole rather than their presenting symptoms. They also called for greater participation in the decisions about their treatment and discharge, including being informed of where they should go for help post-discharge and where they can find ongoing support in the community.

NHS Confederation welcomed the patient-focused report by Healthwatch.

Phil McCarvill, deputy policy director of the organisation, said: “The scale and complexity of the NHS can sometimes make the experience of care feel less tailored to individual’s needs. Delivering compassionate, dignified care must be the top priority of everyone who works in the NHS and change is needed wherever patients’ experience falls below the standard.

“There’s no one-size-fits-all solution so we need local leaders to continue working with key partners, such as local authorities and the voluntary sector, to shape services and ensure the delivery of care in the right way, the right place and at the right time.”

The Royal College of Nursing (RCN) also welcomed the findings, saying it “highlights an important issue for the health service”.

However Dr Peter Carter, chief executive and general secretary of the RCN, said this was not a surprise to nursing staff who “all too often discharge a healthy patient only to see them return to hospital with complications caused by a lack of community care and support”.

He added: “The RCN has worked with its members to identify a number of ways staff can improve hospital discharge for patients. But there are also systemic problems caused by increasingly fragmented services. These problems must be examined by health service leaders.

“Patients deserve to avoid having to go to hospital unnecessarily and the health service as a whole must get better at remembering that health care goes far beyond the hospital doors.”

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