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Tackle ‘root causes’ of delayed discharge, say MPs

  • 9 Comments

NHS England has been accused by MPs of a “poverty of ambition” over solving the problem of delays in discharging older patients from hospital.

The Commons’ public accounts committee called for new measures to tackle such delays, which it highlighted were “bad for both affect patients’ health and the financial sustainability of the NHS and local government”.

“Delayed discharge is damaging the health of patients and that of the public purse”

Meg Hillier

A report published by the committee highlighted an “unacceptable variation in local performance” on discharging patients with “patchy” implementation of good practice.

It highlighted some elements of good practice that all local areas should have – including starting assessments and discharge planning early and joint shared patient assessments between health and social care providers.

But the absence of widespread and effective sharing of patient information was “significant barrier” to effective discharge of older patients, the report warned.

It praised Northumbria Healthcare NHS Foundation Trust for recognising the importance of hospital staff being able to access patient information, which had contributed to an excellent record on reducing delayed discharges.

The trust’s new IT system helped hospital staff, community nurses and social workers to access appropriate parts of the GP record, which helped ensure adequate support was in place when patients leave hospital, the report said.

The important role played by community matrons at the trust in sharing patient information and ensuring continuity of care for patients was also highlighted by the committee.

Meanwhile, the Association of Directors of Adult Social Services told the committee there was local variation in the extent to which community matrons were used.

For example, National Audit Office figures showed that the numbers of nurses working in community services had fallen by 13% between 2009 and 2015.

Problems recruiting nursing staff to work in private sector home care, and residential and nursing homes were adding to pressure on the adult social care market, the report warned.

Public Accounts Committee

Whistleblowing progress by government ‘too slow’

Meg Hillier

Most providers of care were private sector organisations and factors, such as local employment markets and whether the local area has full employment, also had an impact on the local markets, it said.

The committee called on NHS England to co-ordinate work to fully understand the cost of delayed discharges.

It also said the Department of Health, NHS England and NHS Improvement must take steps to understand local variations in discharge performance.

Committee chair Meg Hillier said: “Studies indicate older people can lose 5% of muscle strength per day of treatment in a hospital bed.

“Delayed discharge is damaging the health of patients and that of the public purse. While there have been improvements, the Department of Health and NHS bodies are still failing to properly address the root causes of this problem,” she added.

Latest figures – published by the King’s Fund think-tank since the MPs’ report was finalised – show the number of patients medically fit for discharge but stuck in hospital have reached record levels, costing the NHS in excess of £800m a year.

King's Fund

Exclusive: Challenged trusts commit to recruiting nurses

Richard Murray

Richard Murray, director of policy at the King’s Fund, said: “The growing and unacceptable delays in discharging patients from hospital highlighted in [the public account committee] report symbolise the twin crises facing the NHS and social care.

“This increase has mainly been driven by delays in arranging social care for patients who need support when they are discharged, a direct result of year-on-year of cuts in social care funding,” he said.

Dawne Garrett, RCN professional lead for older people and dementia, said: “Older people benefit from being able to go home to their own surroundings and familiar routines as soon as possible after a spell in hospital.

“Nurses working in the community can help people manage their conditions at home, and prevent expensive and disruptive hospital admissions,” she said. ”Failing to invest in these services is costing too much, and causing too much distress, to be allowed to continue.”

 

  • 9 Comments

Readers' comments (9)

  • michael stone

    If there was a list of NHS 'themes of the moment', then this one would definitely be in the top 5.

    Many people write about this one - for example Professor David Oliver - with the same 'passion/determination/drive' as when I write about dubious MCA/EoL behaviour: the problem is known, it is being worked on pretty hard, and it might possibly be improved (although the final bit - successfully solving the problem - is almost always much harder than identifying the problem).

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  • I am happy to share a Fishbone diagram of delayed discharge from an in depth whole systems analysis of delayed discharge in a NHS trust south of England 2010 if anyone is interested. Completed for Masters dissertation.

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  • milton pena

    I agree that a significant number of patients' discharge is delayed for multiple valid reasons: waiting for essential equipment at home; waiting for a place in a nursing home; waiting in hospital for a final but essential investigation; etc. There is however a significant number of patients that are discharged before they have sufficiently recovered from their illnesses. Some of them are readmitted in a more critical condition and end up staying longer or in a few cases do not survive. Others die at home, but otherwise could have lived longer if allowed to recover fully.
    The fact is that many hospitals in England closed too many wards and there are no sufficient beds.
    Planners and modernisers are mistaken thinking that 'new' practices such a creation of so call 'community teams' lead by 'extensivists' can replace well run and adequately staffed hospital wards.

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  • As far as I am concerned from both professional and personal viewpoint the biggest part of the issue in patient discharge is the same today as it was 35+ years ago when I qualified. Waiting- prescriptions, transport and for doctors to do discharge letters. Thats it. Roles need to develop, we need discharge nurses who can prescribe, who can communicate with pharmacy and who can drive!

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  • In our Trust area can be summed up easily. Nobody wants to keep a patient in longer than necessary, it leads to dependency and depression and many elderly people feeling that they are a burden on everyone.
    Reasons for delay:
    Lack of financial resources from Govt level to County Councils and thus to Social Services departments.
    Social services unable to recruit carers.
    Social services payments to Nursing/Care homes too low and unless a good number of private patients to subsidise ( Robin Hood effect) homes unable to take highly dependent patients.
    Domiciliary care agencies either closing/ unable to take on more/ unable to recruit.
    The 5 major care providers all facing major losses and debt and risk of closure.
    Independent sector unable to recruit staff at all levels.
    No NHS provision for convalescent/ step down care.

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  • It is frightening to read about the lack of capacity of services in some areas to receive patients back into their own homes, when national policy says more care must be delivered at home and in the community. I've just read a quote from one District Nurse who said 'every day is a slog and I return home exhausted.'The Queen's Nursing Institute published its own findings about hospital discharge and transitions of care earlier this year - for more information see http://www.qni.org.uk/news/247

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  • What has all this got to do with sharing patient information in an NHS that patients don't trust?
    What is the point of sharing information when there is nobody out there to listen?
    What is the point in sharing information when the services are not available to help patients?
    ... and sometimes sharing patient information can be very detrimental to the patient e.g. a patient has had a long mental health history but very many years ago. The care received was satisfactory until a GP shared information with the hospital of the patients mental health history.
    From then on, each visit was seen to be about a problem that no longer existed and any symptom the patient has was attributed to mental health.
    The patient changed GP's, changed hospital, had urgently required surgery fro the problem constantly overlooked as being 'mental health' and is now healthy and happy and back ant work ... well into her 70's.
    Sharing patient information can damage your health!

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  • michael stone

    Some of David Oliver’s pieces about this topic are:

    http://www.bmj.com/content/351/bmj.h4244

    http://www.bmj.com/content/351/bmj.h5225

    http://www.kingsfund.org.uk/blog/2016/05/older-people-leave-hospital


    26 JULY, 2016 12:25 PM

    There is an issue, with 'the NHS being rather 'records obsessed'' - as your comment makes clear, this can be a 'bad thing'.

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  • I work with the elderly in a hospital and often it is the relatives themselves that delay discharge. For example one patient's family have taken 10/12 weeks to decide that their very dependent father (who is terminally ill) can no longer go home but needs placement. Of course it is cheaper keeping them in hospital than paying for care. Another patient where everything is set up at home and social services have just spent £500 putting up stair rails etc, the family are now demanding a case conference as to whether the wife will have him home. As long as the nhs lets the family call the shots, you can employ as many discharge teams as you like, and it won't make the slightest difference.

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