What it’s really like to be discharged from hospital?
A new briefing launched today – ‘What happens when people leave hospital and other care settings?’ – outlines where important steps have been made towards improving the discharge process for patients.
However, the 2,083 people’s stories used to compile the findings also continue to show significant variation. This highlights the need for good practice to be spread and properly evaluated to ensure it is having the right impact.
In 2015 Healthwatch England’s ‘Safely Home’ inquiry helped to galvanize system-wide leadership to tackle the underlying problems of transferring patients between services. Yet it is clear from NHS statistics, such as the numbers of delayed transfers of care hitting record levels last winter, that the challenge is still growing.
This new briefing looks at what 46 local Healthwatch heard about people’s experiences of the discharge process since 2015.
Key findings include:
- People still do not feel involved in decisions or that they have been given the information they need, including advice on possible side effects of new medications or who to call for advice out of hours.
- People continue to experience delays and a lack of co-ordination between services, highlighting specific problems with hospital pharmacy services, patient transport, and care homes or family members not being notified when people are about to be discharged.
- People feel left without the services and support they need after leaving hospital, with discharge plans not considering patients’ other clinical needs or home environment, including whether or not patients have carer responsibilities.
One person speaking with Healthwatch Windsor, Ascot and Maidenhead about their experience as a patient said: “Discharged without support, with low blood pressure, very weak and unsteady on my feet and diarrhoea, told to take a walking frame to get around, no question of an assessment regarding the layout of my home and how I was going to be able to get upstairs...which I can't so have to sleep on the sofa....very angry”.
A relative speaking with Healthwatch Hillingdon said about her mother’s experience: “Mum was given the Friday as a discharge date. I arranged with the hospital that she would be brought home in the hospital transport ambulance at 4pm as I had arranged for two carers to receive her at her house. This was necessary as Mum cannot walk, is very deaf, diabetic and needs support.
“For some reason the hospital transport ignored this instruction and took her home at 2pm. They took the key out of her key safe and let themselves in, dumping my Mum on the bed. They left her alone without a drink or any support.”
Improvement case study
Healthwatch Kent found that a third of those they spoke with said they did not feel involved or listened to during their discharge from hospital.
Following the Healthwatch report, the local hospital trust introduced a series of measures to ensure staff are better equipped to provide support, including arranging for hospital staff to visit local care homes and other community based services.
There has also been significant focus on encouraging patients to ask questions about their discharge plan to help them understand the full range of options available to help people with their recuperation.
Healthwatch is calling for a fuller understanding of what’s happening in local areas, with local leaders urged to use the experiences of the people behind the delayed transfers of care statistics to identify where improvements can be made.
The new Healthwatch briefing highlights a number of approaches that are already helping to reduce delays getting people out of hospital, such as ‘Discharge to Assess’ and ‘Red2Green’. However, wherever they are introduced, new programmes must be evaluated to ensure they are having the right impact, and that people are getting home safely and efficiently.
In 2015 Healthwatch Oxfordshire reviewed the way Oxfordshire hospitals handle the discharge process, speaking to 212 patients, 14 care providers, 33 GPs and 44 pharmacists. They undertook the study after GPs in their area had raised concerns with the local CCG about hospital discharge, as Oxfordshire was one of the worst performing counties in the country when it came to discharging people from hospital in a timely and effective way.
Following their report, the local trust set out a number of improvements to the way they handle discharge, including:
• Reviewing the way in which the current discharge liaison team functions to provide greater support across the trust and for very complex discharges.
• Identifying a named nurse to patients as a point of contact for discharge queries.
• A re-designed patient discharge summary with input from clinical staff, including GPs and pharmacists.
• Reviewing all current discharge posters and leaflets for patients, with the aim of producing a comprehensive leaflet. This will include standard useful information, and a section with personalised discharge information for the patient. Healthwatch Oxfordshire approved the wording on the current poster and the same language will be adopted on the leaflet.
• Adopting a discharge plan for each patient, including the named nurse and contact numbers to use in the event of queries.
As a result of these improvements, Healthwatch Oxfordshire noted that the length of delayed discharges came down, and that fewer people experienced a delayed discharge in the following year. Additionally, patients were now more likely to be in receipt of care and medical attention outside of a hospital setting, and were either nearer to home or at home during their recovery time rather than in an acute hospital bed. Healthwatch Oxfordshire also recorded a number of additional outcomes, including that patients who were expected to end their days in a care home were able to die at home instead.
Imelda Redmond, National Director of Healthwatch England, said: “Getting people out of hospital and safely home is not about a single point in time. It is an ongoing process that requires thought, planning and support before, during and after the moment someone is actually discharged. Things work best when staff in all services work together to provide a seamless experience.
“Whilst we heard plenty of positive stories from people moving between hospitals, care homes and their own homes, the number of people stuck in hospital waiting to leave has increased significantly. From what people tell us, it is clear many of the common problems around communication and coordination are still ongoing.
“Healthwatch will continue to play our part, working with hospitals, community services and the public to improve people’s experiences.”