New guidance in March significantly changed how hospital discharge takes place. But how are those changes going? Not well, according to HealthWatch England and the Red Cross in their new report What happens when people leave hospital and other care settings? which reflected on 590 people’s experiences of hospital discharge at the start of the pandemic when this new guidance was being implemented.
- 82% of respondents did not receive a follow-up visit and assessment at home, one of the key recommendations of the policy. Almost one in five (18%) of those also reported having unmet needs, such as equipment, medication or advice
- Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital
- Over a third (35%) of respondents and their carers did not get a contact for further advice, despite this being a recommendation
- Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.
I was interested to read these findings as earlier this year just before COVID-19 became part of our day-to-day we undertook a survey via the Patients Association of friends and family of people who has recently been discharged. We wanted to understand their experience of finding care and what support was useful.
When we asked families for their experiences the guidance was focussed on reducing the numbers of ‘super stranded’ patients. Trusts were asked to do a number of things to help older people be ready to leave hospital as soon as they were medically fit. The majority of friends and family we surveyed (72%) were not informed of the risks for older people of staying in hospital when they were ready to leave and 60% of people said that their loved one was not encouraged to stay mobile or active while in hospital.
We asked families if they had enough support to make decisions about future care and 71% of respondents said there wasn’t enough information.
Now hospital discharge is a very different process – the high numbers of super stranded patients we used to see are a thing of the past – which is a very good thing. But it was sad to see this report finding the new processes left people “feeling unsafe” when sent home. With one in five patients feeling “unprepared to leave hospital” which increased to 27 per cent among those who were discharged at night.
COVID or no COVID, we still haven’t got hospital discharge right for patients and their families.
We know from our survey people want more advice and support – either from doctors and nurses (65%) or a dedicated resource who knows the local care options (62%). They also want a better understanding of funding options including social care and benefits (60%).
Family liaison is key to unlocking the support of families so they can make decisions confidently and quickly, so they feel assured about the next steps for their loved ones, so they know when they can visit them at their care home. In addition, to make new discharge pathways work effectively we need to have the right dedicated support for health and social care teams. This includes coordination of assessments and therapy as well as for meds and equipment, support of commissioned and spot purchased beds as well as overall visibility of the patients care journey. This all sounds simple but without the right focus a lack of coordination can quickly overwhelm and block patient flow.
It’s likely this is going to be a dreadful winter. We can make things easier on patients and families as well as health and care teams by acknowledging simple fixes and release health and care teams to focus on complexity where their unique skills are needed.