Just over five years ago the health service ombudsman published a report revealing the NHS was failing to meet even the most basic standards of care for older people and their families, citing examples from hospitals and GP practices across England.
In those innocent, pre-Francis days the harrowing cases in the report caused shockwaves – one cancer patient’s daughter was forced to spend her father’s last days driving round trying to fill morphine prescriptions because he had been discharged with inadequate pain relief; the husband of another patient was left forgotten for three hours as his wife deteriorated and the decision was made not to resuscitate her.
The ombudsman was reporting on care delivered around the same time as the catastrophic failings were occurring at Mid Staffs, and appeared symptomatic of the same issues – inadequate numbers of staff, particularly registered nurses, and a culture in which staff feared to raise concerns.
But we’ve learned a lot since then haven’t we?
We know that having insufficient registered nurses leads to poorer patient outcomes, and employers are waking up to the fact that staff who raise concerns should be celebrated, not castigated. OK, healthcare providers may not have completely transformed, but most are some way along the journey.
So now it seems the problem has been pushed down the road – literally. The latest ombudsman’s report reveals growing levels of complaints related to discharge and transfer of patients. Four themes emerged from the cases reaching the ombudsman:
- Patients being discharged before they are clinically ready
- Patients not being assessed or consulted properly before discharge
- Relatives and carers not being told their loved on has been discharged
- Patients being discharged with no home care plan in place.
Once again the ombudsman uses some of the most serious examples to illustrate just how bad things can get. And again it makes distressing reading.
One patient discharged in severe pain collapsed and died in her granddaughter’s arms minutes after the ambulance bringing her home had left; she had an infection of the large intestine but had been advised to drink more fluids.
Another died of sepsis because doctors failed to drain an infected lump on his buttock and discharged him with antibiotics rather than order surgical intervention.
The ombudsman identifies three key areas that warrant particular attention:
- Failures to check people’s mental capacity and protect those who lack capacity
- Failure to treat relatives as partners in discharge planning
- Poor co-ordination between services.
I have no argument with the ombudsman’s conclusions, but doesn’t this problem have deeper roots?
In the middle of a nursing shortage hospitals are under pressure to limit their spending on agency staff, and to discharge patients as soon as possible to free up beds.
Meanwhile, the drive to move more care out into the community isn’t receiving the pump-priming required to ensure services actually exist to cater for patients being discharged earlier in their recovery.
The NHS is caught between a rock and a hard place – and the people who are suffering are its most vulnerable patients.