Safely home: what happens when people leave hospital and care settings?
Published in July, ‘Safely home’ reports on the findings of Healthwatch England’s Inquiry into the emotional and physical impact of poor discharge practices. With the help of 101 local Healthwatch groups, over 3,000 people shared their stories about their experiences of the discharge process - of which 1,000 were specifically older people. The Inquiry found that some people were either discharged before they were ready, or they were kept in care for too long, which had a significant and detrimental effect on their lives.
Many people said that, although they may have been deemed medically safe to leave hospital, they did not feel safe or adequately supported to do so. Others spoke of delays to their discharge and the significant consequences of being kept in care too long.
The Inquiry also heard about numerous examples of good practice which are making a real, if small-scale, difference to people. However, in spite of these efforts, this problem still persists.
The researchers were struck by how stark some people’s stories were, especially as it has been widely recognised that discharge processes need to be improved. This is reflected by the more than 20 pieces of guidance produced over the last decade in an attempt to address the issue.
Hundreds of people reported that they had waited all day for medication or transport. Older people with conditions such as dementia, hearing or sight loss, had to wait for hours in a discharge lounge, with little or no information.
The Inquiry also heard about significant delays older people experienced waiting for grab rails or ramps to be fitted at home, or for social care packages to be arranged, or for transfer to a residential home.
Accessing NHS continuing care is ‘shrouded in mystery and disarray, leaving thousands of ill people with no choice but to pay for care.
Data also suggests that older people have the least choice over where they die and have the least access to specialist care. Only 8 per cent of those over the age of 85 dying of cancer die in a hospice (compared to 20 per cent of all cancer deaths).
Using discharge checklists
A survey of 120 trusts found that although almost all had a discharge checklist, less than half check whether people have a safe place to go when discharged, or whether there is basic food, water and heating. One in three do not ensure notes about new medication are properly recorded and passed on to GPs or carers. One in ten trusts do not routinely notify relatives and carers that someone has been discharged. The Inquiry also established that trusts used a variety of guidance from 57 different documents, creating huge variation.
A stark statistic emerging from the Inquiry was that the first three months after discharge is a time of particularly high suicide risk; this is especially true within the first two weeks of discharge. Between 20012-12, there were 3,225 suicides in the UK by mental health patients in the post-discharge period, 18 per cent of all patient suicides.
Albert is a Parkinson’s patient who didn’t get the right support in hospital while waiting for assessment, and for intermediate care. His medication was not given on time and the limited physiotherapy he received while in hospital was inadequate. Health staff did not seem to realise the importance of administering Parkinson’s medication at specified times and the direct impact this can have on mobility if medication times are not adhered to. Albert’s daughter described a shocking lack of awareness by healthcare staff of the specialist care a Parkinson’s patient needs. He was kept in hospital waiting for assessment and then for a place in a rehabilitation unit.
By the time the rehabilitation place became available his mobility had deteriorated so badly that they could no longer do anything for him. During the hospital stay his physical health had deteriorated to a point beyond repair.
Albert has now been moved into a care home, where his health has continued to go down-hill, to the extent that he cannot walk at all now. Albert did not qualify for NHS continuing care and all of his savings have now been spent on care home costs.
Download the full report Safely home: what happens when people leave hospital and care home settings?