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OPINION

'Nurses are key to ensuring all patients are discharged safely'

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Last month our special inquiry into discharge processes was published, revealing that thousands of vulnerable people are at risk because of premature, delayed or unsafe discharges.

We identified that a basic communication breakdown between hospitals and community care providers, lack of involvement of people in decisions about their own care and failure to look at needs of patients were among the key reasons behind discharge going wrong.

Safely Home: What Happens when People Leave Hospitals and Care Settings? includes 3,230 stories, many of which are truly shocking, from people across the country. Older people in need of end-of-life care were discharged to the wrong care facilities without appropriate support, while mental health patients committed suicide having been discharged after pleading not to leave hospital. Homeless people were discharged back to the street only for their health problems to worsen.

As well as the unnecessary human suffering, this comes at a financial cost. Early discharge often results in emergency readmissions to hospital - in 2012-2013, there were one million emergency readmissions within 30 days of discharge, costing £2.4bn.

Let me be clear: this is not about placing blame or suggesting any one party is at fault. Patients tell us they know staff across all frontline services work incredibly hard to deliver a safe, fit-for-purpose service. But there are too many gaps between health and social care services to ignore and it has been going on for too long. Everyone in the system - from A&E nurses to social workers, psychiatrists to housing support officers - needs to sit up, take notice and change how things are done on discharge.

We know there are areas in which discharge planning works very well and have seen examples of excellent practice, in many of which nurse involvement is key. We heard about StreetMed, where nurses work in homelessness outreach teams to provide advice and support to clients who are not currently engaging with primary health care. In Birmingham, nurses work with staff across all services to use the RAID (rapid assessment, interface and discharge) initiative, which has resulted in decreased daily bed use and readmissions.

So, what can nurses do to help ensure a smooth, safe discharge for their patients?

As a crucial point of contact through admission, care and discharge, nurses are in a unique position to be able to engage people in their immediate care and offer broader support. Using care plans, they can ensure all the right questions are asked so all a person’s needs are covered when they leave hospital. This kind of communication should be a basic requirement but less than half of 120 trusts responding to our Freedom of Information requests said they routinely checked whether people have a safe home to go to, and one in three did not ensure notes on new medication were properly recorded and passed on to GPs or carers.

There is a huge support network available to people when they leave hospital - from mental health crisis teams, district nurses and community physiotherapy to social care support. It is important nurses can advise on the support available and work with the agencies that deliver these services to ensure they are accessible.

Ultimately, there is only one way to solve these problems - through collaboration from all services. We want to see all staff across health and social care providers, community services, clinical commissioning groups and health and wellbeing boards working together to ensure the best and safest possible discharge for everyone. By addressing the issue in this way, we can stop vulnerable people slipping through gaps in the system and ensure they get the ongoing care and support they need.

Anna Bradley is chair of Healthwatch England

 

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