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Hospitals send patients home without confirming home situation is adequate, report says

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3974 (Published 21 July 2015) Cite this as: BMJ 2015;351:h3974
  1. Ingrid Torjesen
  1. 1London

Vulnerable patients are being discharged from hospital unsafely and sent home to situations where they have inadequate support because of lack of coordination between health, social care, and community services, an investigation by the healthcare consumer organisation Healthwatch England has found.

The investigation was based on the experiences of discharge of 3230 people considered as vulnerable (elderly people, homeless people, and people with mental health conditions) and on information gathered from trusts through freedom of information legislation and from surveys of patients. It showed that although patients may have been deemed medically safe to leave hospital, many had inadequate support.

Anna Bradley, chair of Healthwatch England, said, “This is not a new problem, but what makes these findings worse is that in many cases some pretty basic things could have made all the difference.”

Often, basic failings were to blame, said the investigation report, which was published on 21 July.1 The freedom of information requests showed that more than half of NHS hospital trusts were not recording whether patients had a home or safe place to be discharged to, including information such as whether there was any food at home or whether the heating worked. A 10th of trusts were not ensuring that a friend, relative, or carer was notified when the patient was discharged, and a third were not ensuring that notes about new drug treatments were properly recorded and passed to GPs or carers.

Many of the problems resulted from organisations failing to think beyond their own direct responsibilities, the report added. Discharge plans often did not consider patients’ other clinical needs or the home environment, including whether patients themselves had responsibilities as carers.

Phil McCarvill, deputy policy director at the NHS Confederation, which represents most NHS trusts, said that when the discharge process did go wrong it was “often because of gaps and boundaries which exist across the health and care system.” He added, “Our members are already making progress in connecting different health services and delivering individualised, person centred care and will be keen to reflect on Healthwatch’s findings.”

Poor discharge was also costly to the NHS, the report said. The National Audit Office reported that each year the NHS in England dealt with one million emergency readmissions within 30 days of discharge, costing an estimated £2.4bn (€3.5bn; $3.7bn).2 A YouGov poll of 3495 adults for Healthwatch England in June 2015 found that 26% of those patients who were readmitted to hospital for the same condition within three years returned within 28 days of discharge and that 17% returned within seven days.

Notes

Cite this as: BMJ 2015;351:h3974

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