Last month the Parliamentary and Health Service Ombudsman published a report of investigations into unsafe discharge from hospital. In the report, nine patient stories were retold (anonymized) from a total of 221 complaints - an increase of over a third from the previous year - that the Ombudsman received regarding hospital discharge in 2014-15.
The report makes for extremely distressing reading, detailing four different issues that patients and their families experienced:
• Patients being discharged before they were clinically ready to leave hospital
• Patients not being assessed or consulted properly before their discharge
• Relatives and carers not being told their loved one had been discharged
• Patients being discharged with no home-care package in place or being kept in hospital due to poor co-ordination across services
In the foreword to the report, Dame Julie Mellor DBE, Chair and Ombudsman, Parliamentary and Health Service Ombudsman said:
"People told us how their loved one's traumatic experience of leaving hospital, including repeated emergency readmissions, added to their pain and grief. One woman captured the sentiment of many, saying she would be 'haunted for the rest of her life' by her mother's avoidable suffering before her death."
From my personal experiences during my father's 19 years with dementia, I would have to say that it was during his weeks in hospital, more than at any other time, when it felt like he was just another number, a problem for the NHS. Often it seemed like he was viewed as a body in a bed - a bed that was shunted from ward to ward, and a body that they mostly wanted to move out of that bed so it could be filled with another one.
Of course staying in hospital beyond when you clinically need to be there isn't recommended - or in other words being a 'hospital hostage' as one of my twitter followers described it - and in an ideal world everyone would experience a well-planned, timely discharge. I've written before about delayed discharge, otherwise known by that awful phrase 'bed blocking' in my blog post 'Dehumanisation in hospitals', but it's important to recognise that the opposite of this, when a person is discharged too early, can be equally serious:
"Mrs T died in her granddaughter's arms after being discharged too soon with severe stomach pain."
Turn the pages of the report and you will find many heartbreaking stories, including that of an 85-year-old woman with dementia who was sent home despite being unable to look after herself or get to the toilet, and a woman in her 80s who was discharged from hospital to an empty house, in a confused state with a catheter still inserted.
When talking about carers and relatives, the report detailed instances where they were not treated as partners in discharge planning:
"Four weeks after Mr Y was admitted, the hospital telephoned Mrs Y to inform her that he was medically fit and would be returning home that afternoon. Mrs Y said that she 'begged' the hospital not to discharge him, but was told that it 'needed the bed'."
Mr Y went on to develop a significant pressure sore and was eventually moved to a nursing home where he died from heart failure.
In summing up, the Ombudsman noted that families and carers play an important role in their loved one's recovery process, and called upon hospitals to:
"Treat them (carers and relatives) as partners throughout the discharge planning process and don't treat their involvement as an afterthought."
Of course I appreciate that a report of this nature is always going to highlight the worst cases, after all the role of the Ombudsman is to deal with complaints that NHS trusts couldn't resolve, and that amongst the millions of people who use the NHS the majority will have far more positive experiences. Nevertheless, the report's conclusion shames us all:
"We found that while some people suffered because of avoidable clinical errors, the majority suffered because they did not have the support they needed despite being deemed medically ready to go home."
The point about people not having the support they needed really gets to the heart of the issue for me. Failing to support people in their own home, be that by supporting a family carer, having professional homecare, or providing appropriate technology and daily living aids - or indeed a combination of all three - is leading to poor outcomes for patients, families and the NHS.
My conclusion: Investment in social care, alongside more integrated, seamless working between health and social care, is of paramount importance if we are to ensure that reports like this aren't repeated in the future.
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