Patients at risk: Watchdog demands health and social care services improve

Hartlepool Civic Centre.
Hartlepool Civic Centre.

A HEALTH watchdog has called on health and social services chiefs to make improvements over concerns about the release of patients from hospital.

Healthwatch Hartlepool found some patients were waiting up to six hours longer than necessary to be discharged following an in-depth study.

It has made a number of recommendations to officials involved in the discharge of patients to prevent problems such as hospital bed blocking.

It comes after a Panorama report highlighted the pressure that A&E departments are facing that is worsened by failures in the system for discharging elderly patients who require further care in the community.

The BBC report found that increasing number of frail elderly patients in contributing to the accident and emergency system being pushed to the limit.

Healthwatch’s study – in response to concerns from patients and organisations – found:

•Care systems for patients after they are released are “complex, fragmented and confusing” and call for an urgent review;

•Concerns there are not enough nursing beds in Hartlepool to meet demand;

•Sheltered accommodation residents discharged without care managers being told;

•Some patients were given medication which was not fully explained to them;

•Problems around dispensing medication on the day patients are discharged caused delays and a review is recommended.

Healthwatch asked patients of Hartlepool and North Tees hospitals, as well as in the wider community, about their discharge experiences.

It was as a result of concerns raised with them by patients and partner organisations, especially for patients who needed a complex package of care and after-discharge support.

The group found the vast majority of releases and care packages run smoothly.

Related story:

A&E ‘pushed to the limit’ by elderly people and unnecessary visits

Healthwatch said they were impressed by the commitment and dedication of all staff involved.

But a significant proportion of patients who took part in the study said that they felt they had not been fully consulted and told what was happening when they were released.

Healthwatch’s report, which was presented to Hartlepool’s Health and Wellbeing Body, stated: “Around 80 per cent of patient discharges are simple or routine and of the remaining 20 per cent only a very small number are problematic and of concern.

“However, hospital discharge can be an incredibly difficult and complex process and in order to function properly requires multi-disciplinary inputs from a wide range of services from hospital, community and local authority.

“Effective communication is vital between and within these organisations and inevitably problems do occur.

“A minor communication problem can have enormous consequences for individual patients and the subsequent provision of timely and appropriate treatment and care.”

Housing Hartlepool reported that in 2013 there were several times when residents were discharged back to sheltered and extra care accommodation without the wardens or care managers knowing beforehand.

Healthwatch is recommending a discharge card scheme carrying the housing providers’ contact details, which was previously piloted, should be looked at again.

Healthwatch is also calling on local health commissioners to carry out a full review of nursing care beds in the community to meet demand.

It is after concerns there were not enough in Hartlepool which stopped patients being able to be discharged into a nursing facility of their choice.

Healthwatch’s report added: “This is clearly an unacceptable situation and as well as resulting in bed blocking can impact significantly on recuperation and expose the patient to hospital infection risks for unnecessarily long periods of time.”

A large number of patients (40 per cent) said they experienced delays of two to six hours, with problems of arranging transport and waiting for medication the main reasons.

Some patients said their release had been delayed because their care package was not ready and there was confusion between the hospital and social services over what care was needed.

One patient was quoted as saying: “I had a hip operation on Monday and could have been discharged on Friday but Hartlepool social services did not review me until Monday which aggrieved me and the nursing staff.”

Healthwatch have recommended patients should be able to be discharged seven days a week.

But Hartlepool Borough Council, responsible for social services, stressed there has never been a delayed discharge in Hartlepool because of a delay in a social care assessment.

Healthwatch is also recommending that clear and easy to understand language is used when discharging patients.

And the group found that many NHS computer systems are not compatible with each other preventing the quick sharing of vital patient information between different service providers.

Healthwatch volunteer Zoe Sherry said many of the investigation’s recommendations are being followed up.

She added: “Some things got dealt with immediately so we did create change as we were doing the investigation.”

Partners pledge to work together

HOSPITAL discharge of patients with complex care needs like the elderly can be complicated and involve numerous agencies.

Hartlepool social services, hospital chiefs and care commissioners said they will work to improve areas of concern highlighted by the Healthwatch group.

Jill Harrison, assistant director for Adult Services at Hartlepool Borough Council, said: “We are very pleased that Healthwatch found that in the vast majority of cases, hospital discharge and subsequent care packages run smoothly and without any problems and that overall it was impressed by the discharge and subsequent care and support provision.

“Working with our partner health organisations, our aim is to give the best possible support to people in all the hospital discharges we are involved in and to that end we are looking closely at the recommendations in this concise and very helpful report.

“Our social work assessments to assist hospital discharges are currently done five days a week and our staff are committed to supporting people to leave hospital in a safe and timely way.

“There has never been a delayed discharge from hospital in Hartlepool due to a delay in a social care assessment – we are one of the very few local authorities in the country where this is the case - and the council is proud that this remains so despite increasing referral numbers and pressures.

“Through the Better Care Fund plan, which will start to be implemented from April this year, the council will be working with its health partners to explore how services can work more effectively together seven days a week.

“In the meantime, there is a seven-day social work service covering the five Tees Valley local authorities to deal with emergencies.”

Ms Harrison added: “The council does not have any control over the time when people are discharged – that is a matter for the North Tees and Hartlepool Hospital NHS Foundation Trust – but it feels that patients with complex packages of care and complex needs should not normally be discharged back home or into a care facility after 5pm and it already does what it can to discourage that.”

The council is also working with the clinical commissioning group (CCG) around nursing beds demand in Hartlepool.

A spokesman for Hartlepool and Stockton-on-Tees CCG said: “A review is currently underway in relation to the provision of long-term nursing residential care across Hartlepool and Stockton-on-Tees.

“The CCG will continue to work closely with local providers to ensure we secure the services required to support the future needs of the population.”

Julie Gillon, chief operating officer/deputy chief executive for the hospital trust said: “We welcome the report by HealthWatch Hartlepool which paints an accurate picture of the situation.

“Our priority as a trust is to ensure patients are discharged safely when they are declared fit to leave our care.

“Patients’ needs can be complex and we have to ensure that appropriate support arrangements are in place.

“We will continue to work closely with our commissioners and health and social care partners to look at how we can continue to make the transition from hospital to home or place of residence as smooth as possible.”