Poorly planned discharges with patients sent home from hospital alone, afraid and unable to cope and without care plans have been criticised for causing “untold anguish” by a health watchdog.
The Parliamentary and Health Service Ombudsman catalogued a series of “harrowing” cases in its publication A report of investigations into unsafe discharge from hospital published today.
These included a confused patient with a catheter still inserted discharged to an empty house, a distressed elderly woman’s family only informed hours before she was transferred to a nursing home and a man with dementia locked on a psychiatric ward for nine months after his local authority refused to fund a place in a dementia care home.
Chairwoman Dame Julie Mellor said: “The people that come to us have been badly let down by the system. How else do we describe the actions of a hospital sending a vulnerable 85-year-old woman with dementia home without telling her family, despite being unable to feed herself or go to the bathroom? How else do we describe the tragic story of a woman in her late 90s who was discharged without a proper examination, to then die in her granddaughter’s arms moments after the ambulance dropped her off?”
She said bereaved families said traumatic discharges added to their pain and grief.
The ombudsman said its caseload on unsafe discharges had soared by a third between 2013 and 2014-15 when it looked into 221 complaints, upholding half of them.
It said it only saw a fraction of cases and across the NHS there were 6,286 cases – a 6.3% increase on the previous year.
The watchdog found patients were discharged before they were ready, not assessed properly or consulted.
It said in many cases it investigated families and carers were not informed about patients’ discharge and no care plan had been put into place or patients were kept in hospital because of poor co-ordination across services.
The report called for better co-ordination within hospitals and with acute and non-acute services and social.
The Queen’s Nursing Institute investigated the barriers preventing effective discharges in its report Discharge planning: Best practice in transitions of care in March.
The Royal College of Nursing’s professional lead for acute, emergency and critical care Anna Crossley said: “Discharge planning is only possible with the right workforce in the right place and with the ability to deliver services across the whole health and social care system.
“Without the right resources, the system struggles to meet demand and this must change.” She said the Department of Health’s new programme to improve discharge was a step in the right direction.
Registered nurse Michael Palmer who works to improve hospital discharge, said there was room for improvement in communicating with patients about the choices available to them “and just as importantly, what cannot be chosen”.
Palmer is on the national executive of the NHS Alliance and said integration could help with discharge planning and “requires significant resources and organisations to release budgets to fund “bridging” packages.