Patients leaving hospital that are older, homeless or have mental health problems are often being left “frustrated” and “bewildered” with tragic consequences in some cases, according to a new report revealing the extent of poor discharge in England.
An inquiry – led by national consumer champion in health and care Healthwatch England – gathered evidence from more than 3,000 people about their sometimes “shocking” experiences.
“Less than half [of 120 trusts] check whether people have a safe home to go when discharged, or whether there is basic food, water, heating etc.”
The report, called Safely home: What happens when people leave hospital and care settings?, identified a lack of involvement of people in decisions about their care and also too little understanding among families and patients about the extra support required.
In one instance, the report claimed that a patient with severe depression and anxiety was discharged from hospital after saying he did not want to go home and was told he could not return if he felt unable to cope.
He was given an appointment for further assessment a week later, but within a few days he had committed suicide.
Basic communication failures between hospitals and community care providers were also noted, leading to patients dying in a place that was not their choice or without the level of support they required.
The inquiry found in one case that an older patient left hospital to go to a care home, but the home was not notified she required palliative care and did not receive the nebuliser she needed, while the nursing care member of staff failed to record her discharge plan.
“Joint action now can deliver the step change needed to make significant improvements to the experiences of people leaving hospital and care settings”
In her online submission to the inquiry, the patient’s mother said: “It was appalling. My mother could’ve had a much more peaceful and dignified death.”
Meanwhile, homeless people were often discharged without accommodation in which to recover, said the report.
Focus groups with homeless patients carried out during the inquiry said they were discharged before they were ready and that staff were often ill equipped to advise them on their options as homeless people.
Less than half of 120 trusts responding to Freedom of Information Act requests by the national body Healthwatch England said they routinely checked whether people have a safe home to go to when discharged and whether they have basic food, water and other means.
In addition, around a third of these trusts did not ensure notes about new medication were properly recorded and passed on to GPs or carers, and 10% did not routinely notify relatives and carers that someone has been discharged.
Other problems identified were that some patients – particularly homeless people – feel stigmatised and discriminated against by staff.
Patients also noted frustration that staff did not deal with their full range of needs, such as both their physical and mental health, or other issues such as their housing or financial situation.
Healthwatch England questioned the slow progress on improving discharge in England and said collaboration between providers, clinical commissioning croups and health and wellbeing boards was required to drive change.
“We believe that joint action now can deliver the step change needed to make significant improvements to the experiences of people leaving hospital and care settings,” it concluded.
Royal College of Nursing chief executive and general secretary Peter Carter said: “Sadly this will not come as a surprise to nursing staff, who all too often discharge a healthy patient only to see them return to hospital with complications caused by a lack of community care and support.
“With the right support in the community, and properly resourced staff who can be responsible for coordinating discharge, patients are less likely to return to hospital, relieving the pressures on the frontline,” he said.