The Welsh Government has advised NHS staff to discharge hospital patients into the community even if there is no care package in place.
In an effort to curb pressures facing the NHS in Wales, hospitals have been advised to consider the suitability of discharge for any of the 1,800 patients across seven health boards who are well enough to leave hospital but cannot due to a lack of social care.
The letter from Sue Tranka, chief nursing officer for Wales, to the health boards offered ‘support and advice to ensure patients are kept as safe as possible, and services are kept as effective as possible over the next period’.
However, experts warned that this could leave vulnerable patients alone in ‘cold homes’ without the support of community services.
Dr Amanda Young, director of nursing programmes at the Queen’s Nursing Institute (QNI), told Nursing in Practice ‘we are concerned that patients being discharged from hospital without appropriate care packages, or inadequate support or reablement, results in poorer outcomes in the short and longer term.
‘Discharges may occur late in the evening with no advance warning to community services, in order to free up hospital beds. Vulnerable people may arrive to cold homes, alone, with community services unaware this has happened until the following day or even the day after.’
This comes as four Welsh health boards declared that they were facing ‘extreme pressure’ following a sharp rise in Covid and flu cases.
Hywel Dda, Swansea Bay and Powys have all said their health and social case systems are struggling to cope with an increase in patients needing emergency care.
Betsi Cadwaldr University health board also declared a ‘critical internal incident’ as ‘unprecedented demand’ forced the service to ask family members to collect any patients who were fit enough to discharge.
Helen Lewis, an advanced nurse practitioner working in Newport, told Nursing in Practice that this was an ongoing issue and that ‘patients have had to be readmitted due to inappropriate discharges’.
Ms Lewis said that the new policy for discharge would put more pressure on general practice and district nurses. ‘The pressure on community care across the spectrum is intense as it can be. Currently, what needs to be avoided is creating so much pressure as to cause the complete collapse of services that are failing both the professionals and also the patients who are vulnerable to readmission.’
Ms Tranka said that the NHS in wales was facing exceptional pressure with more than 500 confirmed Covid cases in Welsh hospitals.
She told the health boards that: ‘We recognise that day to day clinical decision-making must adapt to these exceptional pressures, to ensure the NHS resource is being used for the greatest benefit.
‘Our hospital capacity must be preserved for those at greatest risk with the greatest chance of benefit, this will require us to make every effort to keep people at home, not to admit people to hospital, unless absolutely necessary, and to return those in hospital to their homes or alternative place of safety as quickly as possible.’
This announcement means that patients could be discharged into their homes or care homes without the necessary support from community nurses. The letter suggested that ‘arrangements may not be perfect.’
