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Please tell us about your experiences of hospital discharge - Page 8 - Carers UK Forum

Please tell us about your experiences of hospital discharge

Share information, support and advice on all aspects of caring.
102 posts
Tom Richmond ... Yorkie Post :

https://www.yorkshirepost.co.uk/news/op ... -1-9718489


Bed bound with a broken hip and cancer but will deemed well enough to go home.

My experience of elderly social care in the UK.


THERE are now 71,398 new reasons why the Government’s inaction over social care is as scandalous, and damaging, as its mishandling of Brexit. This is the number of frail NHS patients – invariably elderly – who required emergency readmission to hospital last year within 24 hours of their release.

A figure which equates to the average number of voters in each Parliamentary constituency, this represents a 30 per cent increase over five years and the knock-on effect is longer delays for routine surgery – or A&E treatment.


And the disturbing data from Healthwatch, a watchdog chaired by Sir Robert Francis who headed the inquiry into the Mid Staffordshire hospital scandal, also excludes the 484,609 patients rushed back to hospital last year within a month of their original discharge.

This does not surprise me. Two weeks ago, a ‘ward manager type’ at a leading hospital – previously lauded by Theresa May for its excellence – suggested to an elderly relative of mine that they were well enough to be allowed home, even though they were still bed-bound from hip surgery and cancer treatment.

This was without any assessment of their care needs at home. A fortnight later and it has now required the medical intervention of a consultant to ensure my relative’s physical health – and recovery – is not put at undue risk by such haste.

My relation and others concerned are most definitely not ‘bed-blockers’ – the disparaging term applied to such cases – and the care and compassion of most hospital staff is humbling. It is not their fault that their wards are so short-staffed, even more so at weekends when they can struggle to find time to wash patients, or that social care provision is even more unpredictable than Brexit.

But I think it is reprehensible that Labour’s near-silence has been totally eclipsed by the Government’s scandalous non-silence and the indifference shown by all those single issue Brexit ideologues plotting to succeed Mrs May.

Correct me if I’m wrong, but I do not recall the likes of Boris Johnson, Jacob Rees-Mogg and Dominic Raab, or their hard line Brexiteer allies like Sir Bill Cash and Mark Francois, even talking about social care since that misleading advert on the side of a bus in the 2016 EU referendum about NHS funding.

Even Matt Hancock, the underwhelming Health and Social Care Secretary, and another leadership aspirant with a very inflated opinion of his capabilities, has next to little to say – despite this issue being part of his brief.

Though he announced an extra £240m in his speech to the Tory party conference last October, in addition to the surcharges now levied routinely on local authority council tax bills, Mr Hancock limited his comments to just this: “We need to make sure that money’s well spent, by reforming the NHS and social care system too…”

The excuse was that a Green Paper on future funding – and provision – of social care was imminent. Yet, six months later, this announcement is still pending and almost as overdue as failing Transport Secretary Chris Grayling’s resignation.

A Department of Health spokesperson says it is a matter for Mr Hancock’s office while the latter, when I called out of personal curiosity and professional cussedness, referred me to 10 Downing Street who, in turn, suggested it was a DoH matter. In short, no one had a clue.

All this while the elderly, people who deserve better in their hour of need, pay the price for the prevailing political inaction and inertia as Mr Hancock prepares to further his leadership bid by delivering a speech to the TaxPayers’ Alliance on the potential for “embracing technology in health and social care” – he is so obsessed with digital gadgets that he believes they are the answer to everything.

It should not be like this. As far as I’m concerned, any candidacy for the Tory – or Labour – leadership is invalidated without a clear, coherent and costed social care plan as a pre-condition of the individual’s policy prospectus for power.

This should include expanding recovery care in community hospitals; extra support for home adaptions so the frail do not put their safety at undue risk and sufficient residential facilities for those with long-term care needs.

All consequences of an ageing society, they are all issues that preceded the start of the Brexit debate and will exist long after Britain’s future relationship with the European Union has been reconciled.

But this can’t happen until the Brexit wing of the now dysfunctional Tory party, and others, recognise that this country cannot shut its doors to outsiders if the NHS is to have sufficient staff from the EU – and elsewhere – to function.

If they cared to visit a hospital, they would also see the angst of highly-skilled doctors, nurses and support staff from around the world who do not know, as the political debate becomes more toxic, if they’re still welcome in a country that they would like to call home. It’s embarrassing to witness this.

It is another reason – to add to the 71,398 cases previously cited – why I believe the failure to act on social care is now the more damaging to Britain’s future than Brexit. And that’s saying something.
I haven't met the term "Recovery Care" before, it pretty well sums up one of the functions of the now closed cottage hospitals in my area.
Disabled and elderly people take longer to recover from illness and surgery, they may be "medically fit" for discharge but that is hugely different from being able to manage at home alone.
More than 40 years ago, Christchurch Hospital (an area with one of the highest populations of elderly in the UK) had a "Day Hospital". Run by a consultant geriatrician, staff included OT, physiotherapists. Transport and meals were provided, and if I remember rightly, showers/baths were also available. Patients were referred there before discharge, and a team discussed at a Thursday day conference who was coming in, who wouldn't need as much help, as they were recovering well, and who seemed to need help for longer. It was attended by staff from both the NHS, Social Services, Home Help, and Meals on Wheels. Any member of the team knew exactly who to contact immediately.
It worked incredibly well, and yet 40 years later I'm not aware of any similar arrangements, at a time when there is surely greater demand than ever before. It meant that people could be discharged earlier than otherwise possible, as whatever they needed could be provided the same day. Mobility Aids were all provided via the Red Cross office 50 metres across the car park from the Social Services office.
Several months on and what have we learned.

UNSAFE hospital discharges are INCREASING ... if only going by the number of postings on this issue.

For what it's worth , a MAJOR report from the NHS Ombudsman ... it is truly massive :

https://www.ombudsman.org.uk/publicatio ... hospital-0

( Link on that page to a 30 page report in .pdf format )

The conclusion is worth posting for ALL ... including CUK ... to see :
The people featured in this report all experienced care that falls well below established good practice and in some cases statutory requirements. We found that while some people suffered because of avoidable clinical errors, the majority suffered because they did not have the support they needed despite being deemed medically ready to go home.

Our casework on hospital discharge illustrates how failures in communication, assessment and service co-ordination are compromising patient safety and dignity, undermining patients' human rights and causing avoidable distress and anguish for their families and carers.

To summarise we highlight three key areas that warrant particular attention:

Failures to check people's mental capacity and offer legal protections for those who lack capacity

Guidance on discharge planning is clear that people's consent to discharge arrangements must be obtained in line with the relevant legislation and guidance. Their mental capacity should (when in doubt) be assessed and recorded, and care arrangements that deprive people of their liberty should be identified and authorised according to the deprivation of liberty safeguards. These safeguards were designed to protect people's dignity and human rights; healthcare professionals should be expected to familiarise themselves with these safeguards as part of their professional duty. Therefore, it is deeply worrying that hospitals are not recognising when they are depriving people of their liberty.

Carers and relatives not being treated as partners in discharge planning

Failures by hospitals to notify family members that relatives are being discharged are common features of these cases. Families and carers often play an important role in their loved one's recovery process. It is therefore, vital that hospitals treat them as partners throughout the discharge planning process and don't treat their involvement as an afterthought.

Poor co-ordination within and between services

Poor co-ordination of the discharge process has led to delayed transfers of care, poor or absent care and emergency re-admissions. Our casework exhibits a lack of joint working at various points across the discharge process: within hospital teams, between acute and non-acute NHS services and between health and social care services. Integration has, of course, been a longstanding policy objective of all governments for many decades but this has proved difficult to put into practice. The new care models programme, at the centre of the NHS Five Year Forward View, offers a significant opportunity to break down historic barriers to the way care is provided in England. It is therefore, important that the government uses learning from the new care model pilots, and other recent integration initiatives, to improve people's transfer of care from hospital.

As the final tier in complaints process we on only see a fraction of the total number of complaints about NHS organisations. However, we know that complaints about discharge arrangements have increased recently, and that the cases we have identified are illustrative of problems highlighted by a number of recent reports by national health bodies and organisations representing vulnerable people.

In response to a clear consensus on the need for system wide leadership on this issue, the Department of Health has recently established a national programme to develop a vision for improving discharge.

This rightly brings together organisations across the NHS and local government, and provides an opportunity to develop a holistic approach to improving patient outcomes and experience of hospital discharge. In developing the vision, the Department of Health and its partners should assess the scale of the problems we have highlighted, identify why they are happening and take appropriate action so that all people experience acceptable standards of care on leaving hospital.


MERE WORDS ...

Who out there is protecting our interests in all of this ?


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GREEN PAPER , SOCIAL CARE thread :

https://www.carersuk.org/forum/support- ... read-32659

For the XXth. time :

Recombine the NHS and social care ... under one roof.

A production line ... from the cradle to the ... lime pit.

Fund the whole works through general taxation.
"Develop a vision....! " What a wimpish statement. I'd like to see someone in overall charge wearing hobnail boots carrying big stick who can FORCE hospitals to do what they are supposed to do.

If someone is responsible for Discharges, if they don't do their job properly they should be given a formal warning, and three warnings should lead to loss of job. Of course, everyone concerned is turning a blind eye, everyone blames everyone else. Where does the buck stop - the CARER of course!!!
Tom Richmond : Bed bound with a broken hip and cancer but still deemed well enough to go home – my experience of elderly social care in the UK.



THERE are now 71,398 new reasons why the Government’s inaction over social care is as scandalous, and damaging, as its mishandling of Brexit. This is the number of frail NHS patients – invariably elderly – who required emergency readmission to hospital last year within 24 hours of their release.

A figure which equates to the average number of voters in each Parliamentary constituency, this represents a 30 per cent increase over five years and the knock-on effect is longer delays for routine surgery – or A&E treatment.

And the disturbing data from Healthwatch, a watchdog chaired by Sir Robert Francis who headed the inquiry into the Mid Staffordshire hospital scandal, also excludes the 484,609 patients rushed back to hospital last year within a month of their original discharge.


This does not surprise me. Two weeks ago, a ‘ward manager type’ at a leading hospital – previously lauded by Theresa May for its excellence – suggested to an elderly relative of mine that they were well enough to be allowed home, even though they were still bed-bound from hip surgery and cancer treatment.

This was without any assessment of their care needs at home. A fortnight later and it has now required the medical intervention of a consultant to ensure my relative’s physical health – and recovery – is not put at undue risk by such haste.


My relation and others concerned are most definitely not ‘bed-blockers’ – the disparaging term applied to such cases – and the care and compassion of most hospital staff is humbling. It is not their fault that their wards are so short-staffed, even more so at weekends when they can struggle to find time to wash patients, or that social care provision is even more unpredictable than Brexit.

But I think it is reprehensible that Labour’s near-silence has been totally eclipsed by the Government’s scandalous non-silence and the indifference shown by all those single issue Brexit ideologues plotting to succeed Mrs May.

Correct me if I’m wrong, but I do not recall the likes of Boris Johnson, Jacob Rees-Mogg and Dominic Raab, or their hard line Brexiteer allies like Sir Bill Cash and Mark Francois, even talking about social care since that misleading advert on the side of a bus in the 2016 EU referendum about NHS funding.

Even Matt Hancock, the underwhelming Health and Social Care Secretary, and another leadership aspirant with a very inflated opinion of his capabilities, has next to little to say – despite this issue being part of his brief.

Though he announced an extra £240m in his speech to the Tory party conference last October, in addition to the surcharges now levied routinely on local authority council tax bills, Mr Hancock limited his comments to just this: “We need to make sure that money’s well spent, by reforming the NHS and social care system too…”

The excuse was that a Green Paper on future funding – and provision – of social care was imminent. Yet, six months later, this announcement is still pending and almost as overdue as failing Transport Secretary Chris Grayling’s resignation.

A Department of Health spokesperson says it is a matter for Mr Hancock’s office while the latter, when I called out of personal curiosity and professional cussedness, referred me to 10 Downing Street who, in turn, suggested it was a DoH matter. In short, no one had a clue.

All this while the elderly, people who deserve better in their hour of need, pay the price for the prevailing political inaction and inertia as Mr Hancock prepares to further his leadership bid by delivering a speech to the TaxPayers’ Alliance on the potential for “embracing technology in health and social care” – he is so obsessed with digital gadgets that he believes they are the answer to everything.

It should not be like this. As far as I’m concerned, any candidacy for the Tory – or Labour – leadership is invalidated without a clear, coherent and costed social care plan as a pre-condition of the individual’s policy prospectus for power.

This should include expanding recovery care in community hospitals; extra support for home adaptions so the frail do not put their safety at undue risk and sufficient residential facilities for those with long-term care needs.

All consequences of an ageing society, they are all issues that preceded the start of the Brexit debate and will exist long after Britain’s future relationship with the European Union has been reconciled.

But this can’t happen until the Brexit wing of the now dysfunctional Tory party, and others, recognise that this country cannot shut its doors to outsiders if the NHS is to have sufficient staff from the EU – and elsewhere – to function.

If they cared to visit a hospital, they would also see the angst of highly-skilled doctors, nurses and support staff from around the world who do not know, as the political debate becomes more toxic, if they’re still welcome in a country that they would like to call home. It’s embarrassing to witness this.

It is another reason – to add to the 71,398 cases previously cited – why I believe the failure to act on social care is now the more damaging to Britain’s future than Brexit. And that’s saying something.



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ALMOST REACHED THE SECOND ANNIVERSARY OF THIS THREAD ... STARTED BY CUK.

JUST HOW MANY HAVE DIED AS A DIRECT RESULT OF AN UNSAFE HOSPITAL DISCHARGE IN THOSE TWO YEARS ???

TAKE US OUT OF THE EQUATION AND THAT FIGURE WOULD DOUBLE / TREBLE ???


AND ... WHEN DID WE LAST HEAR ANYTHING POSITIVE FROM CUK ???

WHAT HAVE THE MAJOR CAREE SUPPORTING OUTFITS BEING DOING ???

( AGE UK ... JUNE 2016 ... SINCE THEN ??? )

Cornwall hospital to discharge patients early despite saying it may be harmful

Royal Cornwall hospital move to cut overcrowding described as " Morally repugnant. "


A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise.

The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved.

In a memo sent on 8 January three trust bosses said that the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”.

It had agreed a plan to relieve pressure with unnamed “health and social care partners” after discussing “ a number of possible mitigations”.

The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.

“It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.”

The message was signed by Dr Allister Grant, the trust’s medical director, Kim O’Keeffe, its director of nursing, midwifery and allied health professionals and Susan Bracefield, its director of operations.

The hospital has come under some of the most intense strain seen in the NHS this winter and has spent part of it on “black alert”, which is an admission that a hospital cannot cope with the demand for care. Some people arriving at the A&E unit have had to wait for up to 12 hours and it has asked those with minor ailments to seek care elsewhere, for example at a GP surgery or pharmacy.

The trust’s move has increased concern that hospitals are having to make tough decisions about how to respond to the intense pressures that winter has brought. The Guardian disclosed last month that the Norfolk and Norwich hospital had told its senior doctors to make “the least unsafe decision” when treating patients to help it reduce the intense overcrowding it was facing.

EveryDoctor, a network of frontline NHS doctors, voiced alarm at the Cornish trust’s plan.

“It is incredibly concerning that NHS staff are being instructed to override their expert clinical judgment for patients and provide potentially unsafe care to patients, due to a lack of resource,” said Dr Julia Patterson, the lead for EveryDoctor.

“The NHS has never had a wealth of either beds or staff; resource management has always involved intricate management of budgeting and prioritisation of patient need. This problem in Cornwall is a direct consequence of 10 long years of relentless austerity cuts made to NHS services by the Conservative government.”

However, the Royal College of Physicians said that prioritising beds and specialist care for the sickest patients would benefit those in the greatest need.

“Clinical staff make decisions on a daily basis that consider the risks and benefits to the individual patient and to other patients. Physicians will always put the safety of the individual patient they are caring for first,” said Dr John Dean, its clinical director for quality improvement and patient safety.

“For patients in hospital, if they can be safely supported at home and their treatment and recovery continued there, this should occur as soon as possible. This means that other patients can get hospital care who might otherwise have to wait and be at risk of worse outcomes.”

One doctor at the Royal Cornwall said it gets so busy that medics sometimes have to examine patients who are lying on trolleys in the A&E unit, which compromises their privacy. “There is only one outdated hospital in Cornwall. It simply cannot cope anymore.

“In A&E there are many patients lying on trollies and I am forced to examine and clerk on those trollies as there is simply not enough cubicles.

“There is a heavy workload at the moment. There are always red gaps on the rota. There is absolutely a privacy issue here, I discuss what happened to them and plans in front of many other people.”

Dr Rinesh Parmar, chair of the Doctors’ Association UK and an intensive care doctor, said: “This is morally repugnant and against the very fibre of what doctors stand for. We care for our patients and respect their dignity, not simply dispatching them early into the community to already over stretched struggling services. Our patients deserve better than these short-sighted ploys to generate beds at the expense of their health.”

NHS England has been approached for comment.



Shades of 2004 ... and the very first wave of LA cutbacks in social case.

UNLESS SOMEONE STOPS THE NHS RIGHT HERE AND NOW , ALL HOSPITALS WILL FOLLOW THE SAME POLICY !

Why ?

Because they know that they can get away with it !

Consider yourselves well and truly warned !!!
Cornwall already has a terrible record on social care.
And how many of those 40 new hospitals is Cornwall getting?

This dictate from the top hospital administration goes against the frontline doctors and consultants, and at a time when GPs' professional bodies are declaring that GPs don't have time to do home visits!
And how many of those 40 new hospitals is Cornwall getting?


Cornwall is getting £450m for a brand new hospital.

The money will also pay for improvements at Royal Cornwall Hospital Treliske.


https://www.cornwalllive.com/news/cornw ... ew-3372569


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Royal Cornwall Hospital patients sent home despite fears they may " Come to harm. "

Hospital bosses in Truro came close to declaring a critical incident.


https://www.cornwalllive.com/news/cornw ... nt-3733995


Over Christmas and New Year the hospital was placed on the highest operational level - Opel 4, formerly known as black alert - and reportedly came close to declaring a critical incident.

Patients were forced to wait up to 12 hours for a bed and in an unprecedented move, hospital bosses said that anyone who turned up to the emergency department with a condition not deemed to be urgent, they would be sent elsewhere for the appropriate care.

The memo, written by senior clinicians, recognises that discharging patients "earlier than some clinicians would like" may cause concern.

Hospital bosses insist that doctors are not being told to discharge patients if it is not safe to do so.


OUR NAME FOR THIS THREAD ... THE DUMPSTER THREAD ... BECOMING MORE APT , DAILY ???
Thanks Chris. Wasn't expecting that! So, problem solved then?
102 posts