Reported by the BBC, 26 Oct 2017: The number of patients in England being readmitted to hospital within 30 days of discharge has risen by nearly a quarter in the last four years, a watchdog has said.
Figures compiled by Healthwatch suggest one in five of these potentially distressing readmissions happen 48 hours after being sent home. The watchdog warns patients may be being rushed out early. NHS England says it is impossible to know the reasons for the readmissions. An emergency readmission occurs when a patient needs to go back into hospital unexpectedly for further treatment, within 30 days of having been discharged. Readmissions in such a short space of time raise concerns about patients being discharged unsafely, and about the pressure on hospitals to free up beds.
Reported by NHS Improvement (17 October): An evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital.
The framework consists of eight standards and draws on learning from organisations that have achieved an ‘outstanding’ rating from the Care Quality Commission, and integrates policy guidance and best practice with opinion from patients and carers. The latter was captured through existing resources, including Healthwatch UK (2017), Patient Voices, the Alzheimer’s Society and meeting people and their carers living with dementia.
Designed to be implemented using quality improvement methodology, embodying the principle of continual learning, We recommend it forms part of your quality improvement programme. The principles of the framework apply to all services and you should adapt it to meet your local population and workforce needs.
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Thousands of people treated in hospital every year are kept in longer than medically necessary because of administrative delays or a lack of available care in the community. This causes unnecessary distress for patients and places additional strain on the NHS. Yet tackling the underlying reasons for the delays, whilst also ensuring every patient has a positive and safe experience of being transferred between services, is not straightforward.
To find out more, the Healthwatch network collected and reviewed 3,200 people’s experiences of leaving hospitals and other health and care settings in 2015. It focused specifically on people in vulnerable circumstances, including older people, patients with no home to go to, and those with mental health conditions. The stories shared with the network highlighted both the human and financial impact when discharge goes wrong.
Although the evidence was hard to hear at times, the network's Safely home report played an important role in galvanising much needed system-wide leadership. Since publication there have been encouraging changes at both a national and local level.
However, with a rising population of elderly people, and the cost of care going up it’s not surprising that key indicators of poor patient experience such as the numbers of delayed transfers of care have hit record levels.
To help assess progress from the patient perspective two years on from Safely home, this briefing brings together what 46 local Healthwatch have heard from over 2,000 people about the discharge process since. Whilst there were numerous positive stories about people’s experiences transferring between hospitals and care in the community, it is clear that there is still significant work to be done to ensure discharge is a good experience for everyone. In particular:
- People still don’t feel involved in decisions or that they have been given the information they need.
- People continue to experience delays and a lack of co-ordination between services, highlighting specific problems with being given medication and transport services.
- People feel left without the services and support they need after being discharged.
The report explores these points further in this briefing and highlight where local Healthwatch have been working with partners across health and social care to make changes. If adopted more broadly, these examples have the potential to improve people’s individual experiences and ease some of the broader pressures on the NHS. It also explores the need to carefully evaluate the introduction of such initiatives, in particular the new target to reduce delayed discharges set out in the Mandate to NHS England, to ensure they are having the right impact.
Finally, this briefing seeks to outline how the move towards greater integration of services provides a perfect platform from which to fix the discharge problem once and for all.
The slides from the National Frailty conference are now available for professionals who are members of the future NHS collaboration platform / Supporting Older People living with Frailty in Primary Care. If you are not a member of this platform you may access them too.
If you would like an invitation to join this collaboration platform please email
Kristin Bash: Current and future cost of frailty to health and care
Alistair Burns: Frailty and Older People's Mental Health
Andy Clegg: Future eFI developments
Tom Gentry: Living with 'frailty': older people's experiences and the role of the voluntary sector
Adam Gordon: How new care models are (likely to be) making a difference to residents in care homes
S Humphreys: IT Solutions to support prevalence, case finding, diagnosis and care planning in dementia
Helen Lyndon: Meeting the needs of patients with frailty and multimorbidity: 'Frailty rarely travels alone'
Dawn Moody: 'Finding Frailty' - System benefits of frailty identification
Dawn Moody: Workshop: Identifying frailty in Practise - case finding and management
Matt Thomas: Restoring health and independence: a hospital's role and responsiblities
Martin Vernon: Find, Recognise, Assess, Intervene, Long-Term
Mick Ward: Strategic approach to tackle social isolation and loneliness
Following the National Dementia Strategy and the Government’s 2020 Dementia Challenge dementia is a priority area for NIHR research funding with a target of increasing the numbers of participants with dementia into clinical research trials to 10% of this patient group. The NIHR has been supporting recruitment of people living with dementia through the NIHR Join Dementia Research register, the ENRICH Engaging Research in Care Homes network and the NIHR Clinical Research Network DeNDRoN. Focused funding calls are also increasing the breadth of research and increasing capacity in this area. Recruiting people living with dementia to research studies however can be challenging. This paper discusses what researchers need to consider when planning a study involving patients with dementia.
Many people with dementia will not have capacity to give informed consent to take part in research. The Mental Capacity Act 2005 (MCA) governs how we decide whether a patient has capacity. The MCA is a very clear piece of legislation and before conducting research involving patients living with dementia, you must become familiar with its content, particularly sections 30 to 34 which cover research. Your knowledge of the act needs to be demonstrated in any funding or research ethics application.
Intermediate care focuses on the person's own strengths and helps them realise their potential to regain independence. This new guideline from NICE covers referral and assessment for intermediate care and also supports providers to develop a person-centred approach and to deliver efficient and cost-effective services. It has been developed by the NICE Collaborating Centre for Social Care, a partnership led by SCIE.
Intermediate care including reablement
This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.
This guideline includes recommendations on:
- core principles of intermediate care, including reablement
- supporting infrastructure
- assessment of need for intermediate care
- referral into intermediate care and entering the service
- delivering intermediate care
- transition from intermediate care
- training and development
The powerpoint files supporting presentations at the September 2017 BGS Falls and Postural Stability Conference will be made available over the next week as and when presenters authorise publication. The files are in secured PDF format and will remain on the BGS website for two years.
Aamer Ali et.al: Developing Effective Falls Services Workshop
Frances Dockery: Falls in a FLS
Adam Gordon: Falls in Care Homes
Brendon Stubbs: Severe mental illness, poor bone health and falls: The potential for physical activity
Celia L Gregson: The new NOGG guidance - more falls friendly?
Helen Roberts: Frailty and Falls - an important connection?
Dawn Skelton: Feet, footwear and falls
Iain Wilkinson: Sepsis in Hip Fracture Care