Hospital discharges and delayed transfers of care are a common topic in health and social care. They are blamed for bottlenecks in the system and overspends by NHS Trusts. But there’s more. Each delayed transfer or hospital discharge is a person, a cherished family member, with feelings, needs and human rights. However, it appears from recent investigations that the individual, the human being, isn’t always at the centre of the process, where they really should be.
A Report of Investigations into Unsafe Discharge from Hospital has been published by the Parliamentary and Health Service Ombudsman. It highlights cases investigated by the Ombudsman service where people have been discharged from hospital before they are fit to leave or without making sure they can cope on their return home.
It contains, what the Ombudsman herself calls ‘harrowing ordeals’, of real people’s lives being affected. I think it should be required reading for all health and social care professionals, to see the person beyond the workload. Here are just four examples.
Mrs T, who was in her late 90s, had been diagnosed with a bladder infection by her GP, who also noticed her stomach was swollen. She became unwell overnight, so her granddaughter called an ambulance. Ambulance crew also noticed her stomach was swollen.
At the hospital, Mrs T’s examination did not focus on her severe stomach pain. She was told she had a bladder infection and discharged. Just after the ambulance had dropped her home and left, Mrs T collapsed and died in her granddaughter’s arms. The Ombudsman concluded that, ‘had the doctor physically examined her stomach, it’s highly unlikely that she would have been sent home’.
Clearly, Mrs T’s granddaughter experienced a great deal of shock and distress from her grandmother’s sudden death.
Mrs K, an 85-year-old woman with dementia, was discharged home without her family’s knowledge. When her daughter arrived to see her the following morning, she found her mother without food, drink or bedding, unable to care for herself or get to the toilet.
Mr A had vascular dementia and a personality disorder. After a series of incidents at his care home, he was admitted to a psychiatric ward where he remained as an inpatient for two years. Once he was considered fit to be discharged, discussions began between the hospital and the council. The council decided that Mr A was ‘beyond social care’ and refused to fund a dementia care nursing home for him. Despite a series of discharge planning meetings, it was nine months before a suitable nursing home was found. During this time, he remained in the locked psychiatric ward without the hospital going through the necessary procedure to see whether this was a deprivation of liberty.
Mrs Z who was 80, had Parkinson’s disease and dementia. She was re-admitted to hospital several times after being repeatedly sent home where she was unable to cope. She later died in hospital. Her daughter said she now has nightmares and can’t sleep because of what happened. She said she will be haunted by the way her mother was treated for the rest of her life.
Where’s the humanity?
The report concluded that, ‘The people featured in this report all experienced care that falls well below established good practice and in some cases, statutory requirements. 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. Our casework on hospital discharge illustrates how failures in communication, assessment and service co-ordination are compromising patient safety and dignity, undermining patients’ human rights and causing avoidable distress and anguish for their families and carers.’
Is the system that broken? Is there too little money, too much work, too many political issues, meaning vulnerable people can’t expect to be kept safe, supported and helped in their time of need? Families need to be able to trust professionals to care for their relative, as they deserve to be cared for. We need to move beyond the workload, the figures and the costs, and onto the lives of the people being affected.
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