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‘Political maladministration’ forcing staff to discharge patients unsafely

Patients who are unfit to leave the hospital are being discharged because of problems with trust leadership and lack of resources, the Public Administration and Constitutional Affairs Committee (PACAC) has warned.

The PACAC’s latest report was commissioned in response to a Parliamentary and Health Service Ombudsman (PHSO) report into the cases of elderly patients who had been discharged despite being physically or mentally unwell or unable to care for themselves.

However, the PACAC report said that the distressing cases in the PHSO report were not “isolated incidents”, but evidence of “a persistent problem”.

Bernard Jenkin MP, chair of the PACAC, said: “Hospital staff seem to feel pressured to discharge patients before it is safe to do so.

“Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge.”

Witnesses told the committee that hospitals were under pressure to discharge patients because of a lack of beds, shortages of staff who were able to assess patients’ need, and a lack of a ‘person-centred’ approach to care.

Some hospitals said there were ‘discharge teams’ in operation, whose purpose was to identify as many patients that could be discharged as possible.

Best practice guidance on discharge exists, but was not applied consistently across hospitals, the report noted.

Hospitals as a whole are under severe pressure, with a recent report from the Royal College of Physicians warning that the NHS is “at the point of no return” because it is so “underfunded, underdoctored and overstretched”.

In addition, the PACAC said divisions between health and social care were making it so hard to ensure patients were properly cared for upon discharge that it amounted to “political maladministration”.

The PACAC said hospital management need to communicate to staff that “organisational pressures should never take priority over person-centred care”.

It added that NHS England and the health secretary should respond to the report by setting out how they will improve understanding of the scale of unsafe discharge and how much it contributes to readmissions, and how they will ensure that best practice is implemented.

The committee stopped short of recommending a ban on discharging at night, when unsafe discharges are most likely to occur, but said that the health secretary should ensure that patients are only discharged at night if they want to be.

In addition, the PACAC said that whilst the government has committed to greater delivery of integrated care, it was concerned that large portions of the Better Care Fund, one of the sources of funding, are meant to be delivered from the New Homes Bonus.

The PACAC said the government needed to develop a “long-term, sufficient, sustainable, integrated approach to adult social care funding”. It also backed recommendations that the PHSO should be integrated with the Local Government Ombudsman, saying this would deliver greater oversight to help tackle the problem.

The Public Accounts Committee (PAC) published a report into the opposite problem of delayed discharges – where patients are not discharged despite being better off at home because of a lack of social care – saying that it was due partly to a lack of NHS leadership in fixing the problem.

A Department of Health spokesperson said: "Patients should only be discharged from hospital when it's clinically appropriate and safe for them and their families — and the best way to ensure that is to meaningfully integrate health and social care. We are investing billions to do so over the course of this Parliament to improve the experience of patients, many of whom will be vulnerable.”

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