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'We must ask patients what care and support they feel they need'

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Today, I made my first donation of 2016 to the charity Give Directly, which uses mobile technology to transfer money to some of the world’s poorest people every month for a year, effectively doubling a family’s annual income. 

michael palmer

michael palmer

Give Directly identifies extremely poor people in Kenya and Uganda using a variety of criteria and then sends them money to use as they see fit – no strings attached. Evaluations show that people use the money for the things that are most important to them, including food, education, medical expenses and home improvements.

Direct cash transfers are supported by some of the strongest evidence, including randomised controlled trials, for anti-poverty interventions. The evidence is unequivocal: direct cash transfers reduce malnutrition and ill health (including HIV infection rates), increase earning and capital, improve schooling and have no impact on “luxury” spending such as alcohol and tobacco. These benefits appear to last for many years after the cash transfer, contrary to standard development and economic theory.

This model combines two elements that are critically important to nursing in Britain – that we should trust that the people we are trying to help are capable of making the best decisions for themselves, and that we should make sure the things we do are supported by available evidence, whether or not they fit with current thinking or theories.

A part of my role at Royal London Hospital is to lead on discharges. Recently we have had a number of discussions with our local authority partners about our referrals to social services (assessment notices under the Care Act (2014)). Current issues have included failure to document whether the person has consented to referral, and not including the person’s views about their care and support needs. This has used the time of overstretched social workers who have started work on a case only to find that the person either doesn’t want support from social services or wants their care and support needs to be met using other assets, such as their family or community. The Care Act states that a person (and, when appropriate, their carers) must be consulted about the support they may need upon discharge and their consent must be gained for referral to social services.

Given the pressure that hospitals face, I understand the logic that prevails when we send an assessment notice “just in case” someone has care and support needs upon discharge. I also believe that there is a training need among some of our nurses to understand the changes brought in by the Care Act and the implications for practice. However, it is not fair that we shift the responsibility for gaining or checking consent for referral to social care colleagues, who are arguably facing deeper cuts to funding than we are in the NHS. The legislation is clear – consultation and consent is a health service responsibility and, as such, nursing should address this.

Much like the people in Kenya and Uganda who will benefit from my donation, people being discharged from hospitals understand the assets that are at their disposal and have the best understanding of how to manage and improve their lives. I believe that people know best. So as I work with my colleagues to improve the way we discharge people from hospital, I am going to make sure that anyone who makes a referral to our local authority partners has had a conversation with the patient concerned about their views of their care and their views of their support needs on discharge – and I am going to make sure they document it accurately.

Michael Palmer is senior clinical site manager and discharge lead, Royal London Hospital

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