How can this happen

[jenny lucas]

LB - Mr Smith's seems to be a prime example of the 'Just get his bed free ASAP!' incentive that currently operates in hospitals.

That's why I say that the incentive has to change from 'get our beds free ASAP!' to 'don't breach the unsafe discharge' rule.

Of course, the underlying problem behind the 'free up a bed ASAP!' imperative currently operating is that there are insufficient hospital beds in the first place!

Overall, the current situation seems to be analogous to a patient 'bleeding out' and medics just rushing around with sticking plasters to try and stem the blood loss....utterly insufficient all round.

I still think the major 'blockage' in reforming the situation (ie, reorganising for maximum efficiency and therefore least waste of money, plus just MORE money scaled to the increasing need building up because of ageing populations, more elderly people surviving with complex health needs, more social isolation etc etc etc etc!), is with the 'top bosses' in the NHS/SS.

When you pay a CEO of a trust, or SS authority, or whatever, a humungous salary (often larger than the Prime Minister's!) you create what I basically a 'traitor' to their own staff. They become the 'stoolies' of the Chancellor/Minister, whatever, and in exchange for their humungous salaries they then 'betray' their own staff, by constantly pressurising their staff to do more with insufficient resources, and they never, ever do what a good manager does when faced with an intractable, underfunded department - ie, push the problem 'up the line' to their own bosses!

It is the CEO's of health trusts and their equivalent in the SS who should be ganging together, and shouting VERY LOUDLY at their own bosses higher up, that they have been given an impossible task with insufficient resources, and demanding more resources to fulfil their tasks, shouting in the press, etc etc etc.

But no, central government simply bribes these individuals to put up and shut up, and pass all the pressure downwards on to the coal-facing staff......

I think, coming back to my point about Cancerworld, the reason the TWW (Two Week Wait) initiative has been so successful, is because it has been imposed from 'beyond' the hospital trusts, via the creation of a Cancer Czar (yes, humoungously, but sigh, that is what such people extract!) (top guys always pay each other loads, because each person on a humoungous salary acts to justify every other person at their level on such salaries!). The Cancer Czar was motivated to achieve their goals (ie, TWW throughout all hospitals), and not to keep the lid on a situation that was bad for patients.

Eun, it is interesting what you say about the motivation of CUK itself. I can't comment, obviously, as I don't know the ins and outs, and even if your comment were true (as I say, I have no knowledge either way!), obviously CUK do hugely good simply by its own existence to provide information for carers, and to host this forum! Could they do more? I don't know.....it would be great it they could! (allowing for resources etc....)

However, your point, for me, references similar organisations in Cancerworld. In Cancerworld there are any number of 'anti-cancer' organisations that are patient-led or patient-focussed, and yes, they do do useful things, and they do provide information and forum facilities and do encourage and facilitate things like greater take up in clinical trials etc etc, so I don't 'diss' them at all ....BUT, they are, mostly, from what I can see, 'on board' with the NHS, and, perhaps, in that unpleasant but perhaps sometimes accurate phrase that I think the Chinese Communists used to use, can possibly be seen as the 'running dogs' of the NHS....

A friend of mine in Cancerworld says the danger of getting involved in such 'patient' organisations is that in the end you 'go native' with the NHS, and cease to be an effective voice to challenge or question. You become a 'tool' of the NHS itself (both in a good way, as I describe above, but also in a bad way because you just become an extension of what the NHS and the medical profession itself want patients to be - ie, docile and obedient!!!)

[Carers UK Admin]

Hi everyone,

Our Policy team have sent over some more general policy info, as we know this is a very important topic, sadly with devastating consequences for some families:

A carer should be involved in the discharge procedure and the hospital discharge policy should emphasise the importance of doing so. Despite this, we know that hospitals and staff on the ground are often not involving carers properly, not ensuring proper support is in place for them and the person they care for at home or even informing them that the discharge is taking place. When hospital discharge is poorly carried out, it is distressing for the person with care needs and their family. It also makes it more likely that the patient will be readmitted, often in an emergency situation costing the NHS more in the long term.

Highlighting this poor practice and urging the NHS to do more to improve hospital discharge is something we’ve been doing for several years. We have used evidence from our State of Caring Survey of carers to make these arguments, for example in consultation responses to the Health Select Committee and to NHS England consultation on the NHS Constitution.

Before the General Election we included it in submissions to political parties through our Carers Manifesto which included a call for ‘Carer-friendly hospitals’ – to involve carers in hospital admissions and discharge and decision making, to recognise carers role as expert partners in care and to provide carers with additional support including discounted or free parking and hospital-based access to information, advice and support.

We frequently raise it in our conversations with health and care professionals, for example in a blog for the Royal College of Surgeons on the importance of involving carers in hospital discharge: http://www.rcseng.ac.uk/blog/hospital-d ... ing-carers

Work to engage hospitals during Carers Week also emphasised the importance of thinking about and involving carers, particularly at key times such as discharge.

We are hearing from carers that this continues to be an area where hospitals are not putting in place the care and support they should be for families and the continued pressure on social care budgets locally is in many cases contributing to the difficulty of getting the right support at home after leaving hospital.

It is an area are planning to do more work on in the near future including gathering evidence to influence the Government’s plans for the extra demands in winter where emergency admissions often increase. We will be once again reminding the NHS and Government that failure to properly support and involve carers in the move from hospital to home with the right planning, equipment and care support puts terrible pressures on families causing distress to them and those they care for and ends up costing everyone more when returning to hospital becomes the only option for many. We’ll also be influencing a best practice guide for the NHS being produced by the National Institute for Health and Care Excellence which is currently in production to make sure carers are properly included.

A few questions have also cropped up about how Carers UK gives advice and information to carers, and if we're able to take on 'case work'. Here's a response about some of these issues that should clarify what we do:

Our Adviceline is set up so carers can contact us for one-off advice, no matter their situation. Case work involves an adviser working with an individual on a continuing and regular basis and it can usually only be accessed through a referral from a third party. Case work is usually face-to-face, involves regular meetings with an adviser, and can also involve advocacy (advisers taking action on the individual’s behalf).

We don’t provide case work because to provide this high level of contact with carers across the UK would require more resources then we have (hence the amount of carers we could help would significantly decrease).

However we can provide ongoing support to carers. Many of our enquirers contact us multiple times, often for advice about the same issue. There is no limit to the amount of times someone can speak to us and with their consent we can keep notes of their calls so they don’t have to keep repeating themselves. We help many people to overcome difficult situations (such as benefit appeals, complaints about NHS care, requesting re-assessments) in this way.

I hope this helps, do get in touch if you have any further questions.

All the best,

Kate

[Londonbound]

The guidelines that the carer should be involved in the discharge package, I have never been involved by any hospital, basically never spoken to, I don't exist.
Maybe I need a T shirt saying i am an unpaid carer.
In many cases exactly as the article says, patients are just sent home and basically dumped in the lounge and the ambulance drives off.
We the unpaid carers don't even know, no one tells us, it's just by chance we look out the window and see an ambulance.
There needs to be more a lot more co ordination, some of the elderly have social workers/care packages, never see the social workers, don't even know who the social worker is?
When hospital discharge is poor it is distressing for the person with care needs and their familys.
But these have no familys, it is not distressing for the familys as the familys don't exist, it is distressing for the unpaid carers who have to drop everything and go around and care.

Who should the hospital be contacting in this case, one poor old chap put me as his next of kin, but the hospital never contacted me, just sent him home.

so who should I be talking to about getting additional support when Mr Smith gets discharged, the head nurse?
There is no unpaid carer guidance in the hospital on the wards, no leaflets, no carer friendly free parking, I have to pay like everyone else.
The hospital could have a room with a couple of unpaid carers advisers and a load of leaflets, it could have a desk by reception, but nothing.
Carer friendly hospitals just don't exist, I have never been offered any help or support not even a cup of tea.