News

Continuing Healthcare

February 10, 2017

“Everyone is well meaning but no-one is in charge of the process”. Learning the lessons of Iris’s six-month hospital delayed discharge

Media interest in the issue of delayed hospital discharges recently found an individual focus in 89-year-old Iris Sibley.

Iris spent six months in hospital waiting for a care home place where her nursing and dementia needs could be met.

She was in hospital in Bristol and although the length of her delayed discharge is particularly concerning, trusts across the country would recognise there are many others like Iris facing very long stays because they are unable to safely move into community based care.

Iris’s story was told on Radio Four’s Today programme, with health representatives talking about staff making a “more or less daily effort” to call care homes.

Radio Four presenter Justin Webb concluded: “Everyone is well meaning but no-one is in charge of the process.” This is echoed by Iris’s son John, who says: “It is just a system where you are going from one organisation to another and no-one seems to be co-ordinating.”

They struck me as very insightful comments. Both the family and the presenter were not blaming the staff involved, but were clear that the flaw lies in the process; in trying to accomplish a very challenging task without co-ordination.

Working in this field for 20 years, we recognise that hospital discharge for patients with complex needs requires relentless focus and co-ordination.

We expect the process of co-ordinating discharge to take at least 25 phone calls (often on a single day) for patients moving from hospital into a care home, if their needs are fairly moderate.

We have previously described how care for people with Iris’s needs, both nursing and dementia care, is particularly scarce. For patients like Iris, we would expect our care advisers to be making at least 40 phone calls simply to source an appropriate care home and that is before the process of arranging discharge begins.

Our advisers contact care homes by calling them; we don’t use automated systems or email for first contact. We offer to visit and transport families on care home visits, which is highly valued by families and enables our advisers to build up strong relationships with homes.

We recognise the need to ‘go the extra mile’ to achieve discharge. For example, when there was a delay in a Fast Track hospital patient being assessed because the care home manager had been on holiday, our adviser visited the care home and persuaded a manager from the same care home group to do the hospital assessment instead.

Crucially, our advisers work evenings and weekends. This makes an enormous difference in reducing delays, particularly as this is often the time when working families are able to spend time choosing and arranging care. Our advisers always contact families within 24 hours of a referral being made and once an adviser is allocated a patient, they are wholly responsible for taking charge of their discharge.

Going back to Iris: hospitals need a service wholly focused on discharge. It is not realistic to expect hospital based staff, who have other priorities, to do the huge amount of time-consuming work to achieve complex discharge in a timely way. Equally, it is easy to see how this challenging task becomes fragmented when different professionals and individuals provide input but no one person is in charge of the whole process.

Read more about our hospital discharge service including key performance indicators, evaluation and service user feedback.