In their 2011 report on NHS care of older people the Health Ombudsman found that discharge arrangements from hospital could be shambolic and ill prepared with older people being moved without their families’ knowledge and consent. It is disheartening that the latest report into the same subject reveals continued failings with no sign of improvement.
The Ombudsman report states that in 2014/15 221 complaints on this issue (an increase of over a third in complaints in the previous year) were investigated by them from a total number of complaints of well over 6,000
The problems range from the most serious clinical errors to patients being discharged with no home-care plan in place or being kept in hospital due to poor co-ordination across services
The most fundamental decision that clinicians need to make is whether a patient is medically fit to leave hospital. Mistakes made at this point can seriously compromise patient safety, leading to emergency readmissions and, in the most tragic cases, potentially avoidable death. In addition, while a person may be ‘medically fit’ to leave hospital, they may not be practically ready to cope at home. If a rounded picture of a patient’s needs (including their mental capacity) is not established on admission to hospital and then regularly monitored, they could be sent home alone, afraid and unable to cope.
When a loved one is admitted to hospital it can be an extremely worrying time. But it can also be highly distressing to find out that an older and vulnerable relative has been sent home alone, without your knowledge, unable to feed and clean themselves. Many relatives are their loved one’s carer, so failing to notify them can have a direct impact on the care they provide, and on their loved one’s recovery and wellbeing. Lack of integration and poor joint working between different aspects of healthcare, such as hospital and community health services can result in people being discharged without the support they need to cope at home.
It is understood that Hospital management need to avoid the costs incurred in delayed transfer or discharge but this must be considered in the light of the human cost where dangerous practice has not only caused suffering but also led to death.
Best practice guidelines have been in place for at least the last ten years on this issue and yet this report suggests there are a worryingly increasing number of cases where it simply is not being followed.