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Found 167 results
  1. News Article
    A trust has admitted it is having to discharge patients inappropriately into care homes or community hospital beds because of a shortage of home care workers. A report to East Kent Hospitals University Foundation Trust’s board last week revealed that 160 extra beds had been commissioned to maintain flow across the local health economy “due to insufficient domiciliary/care package capacity.” It went on: “The clinical commissioning group have tried via Kent County Council to commission additional domiciliary care without success. It is acknowledged by the local health economy that it is important to withdraw from these additional beds as quickly as possible as they are not a cost-effective resource and more importantly, in many cases, they are not the ideal discharge destination for those patients who could have been discharged home with a care package. “Patients are being transferred into community hospital beds or residential home beds due to a lack of domiciliary care packages. Although this is a national issue, it will not be resolved locally until appropriate pathway capacity is commissioned.” Professor Adam Gordon, president elect of the British Geriatrics Society, said: “If people have been sent to a care home when they don’t want or need to be there that can affect their motivation and result in a form of deconditioning. One of the principles of effective rehabilitation in older people is that if you don’t use it, you lose it.” Read full story (paywalled) Source: HSJ, 17 March 2022
  2. News Article
    A diabetic pensioner died on the roof of a hospital after staff physically ejected him despite being in a “confused” state. Stephen McManus, a long-term Type 1 diabetes patient, had earlier been rushed to Charing Cross Hospital in west London while suffering a hypoglycaemic episode. Despite colleagues having expressed concerns about his slurred speech and erratic behaviour, a junior doctor decided the 60-year-old had the mental capacity to go home. He was wheeled out of the building by security guards, despite having no phone, money and being in his slippers. His family had not been contacted to inform them he was being discharged. Some time later Mr McManus re-entered the building and managed to gain access to a construction area, somehow finding his way onto the roof. He was found dead the next morning following a police search after his family reported him missing. An inquest has begun trying to establish why Stephen was allowed to leave the hospital in the first place and how he was able to access a potentially dangerous zone. Mr McManus’s family say the case raises profound questions about the treatment of diabetic patients in the NHS. “My father was an extremely vulnerable patient and the nature of his removal from the hospital is inexplicable, Jonathan McManus, his son, told The Telegraph. “Had he been kept in hospital he would no doubt be alive today.” Read full story Source: Yahoo News, 19 February 2022
  3. Content Article
    A delayed discharge is when a patient no longer requires hospital care but isn’t able to leave. Earlier this winter, hospital trusts in England were asked to work with local partners to cut delayed discharges by half by the end of January. Natasha Curry and Liz Fisher show how the situation has actually got worse since, and discuss the possible reasons why.
  4. News Article
    The number of patients in hospitals who are ‘medically fit’ to leave has increased in January, despite NHS England targets for trusts to dramatically reduce the numbers. Internal data seen by HSJ suggests there were an average of 12,819 patients who no longer met the ‘criteria to reside’ in NHS hospitals in the week to January 23 – up from around 10,500 before the Christmas period. Last month, NHS England told local systems to dramatically reduce their numbers of medically fit patients who remained in hospital, as they aimed to free up beds amid a surge in covid-19 admissions fuelled by the omicron wave. It told local leaders “a significant proportion of discharge delays are within the gift of hospitals to solve”. The message was reiterated by NHSE’s regional teams at the start of January, with systems told to reduce their numbers of medically fit patients by between 30 and 50 per cent. Yet the proportion of ‘medically fit’ for discharge patients occupying NHS general, acute or critical care beds has also been rising, from around 12% in December to around 14% in mid-January. Delayed discharges are frequently cited as the main cause of long delays for patients being admitted through hospitals’ emergency departments, which have significantly worsened in recent months. Read full story (paywalled) Source: HSJ, 26 January 2022
  5. Content Article
    This report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a local pilot, which has been launched to evaluate HSIB’s ability to carry out effective investigations occurring between specific hospitals and trusts. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. On her admission to her local emergency department (ED) after a fall at her nursing home, Mrs E, a woman aged 93 with dementia, was booked into the ED with incorrect patient details, resulting in a new patient record being created. She was discharged that day but readmitted the next day after a second fall. She was booked into ED with the new patient record (which contained the incorrect patient details) and had an x-ray which confirmed she had a broken hip, subsequently being admitted to hospital for surgery. Mrs E had surgery the next day, during which the pathology department identified a problem with the accuracy of her patient identification information and following surgery her two sets of patient records were merged.
  6. Content Article
    HSJ’s inboxes are currently heaving with frustration and fury on a rare consistency of theme; the build up of medically fit patients who can’t be discharged from hospitals. Here’s one example from an exasperated, experienced manager, who spoke of “real failure in social care – long stays growing and no capacity to discharge to, a. Homes closed due to infection, b. Homes going out of business c. Homes unable to come and assess patients as no spare staff, d. No care packages as staff sick or none available due to lack of capacity e. social workers and others needed to make assessments in very short supply”. “We keep getting told we’ll cope and get through but we’re really not… The will to continue is beginning to break down with refusals to redeploy and high sickness absence on top of enforced absence due to covid. A seemingly mad commitment to grind through elective stuff…
  7. News Article
    NHS England has encouraged trusts to consider taking legal action against patients who refuse to leave hospital beds when step-down care is made available. NHSE guidance sent to trusts late last year, seen by HSJ, advised clinicians that where people “with mental capacity” refuse to vacate a bed because they do not accept NHS-funded short-term care offers, the “local discharge choice policy” should be followed, which could involve legal action. The guidance said the process “may include seeking an order for possession of the hospital bed” under civil law, and that “appropriate formal notification of the process must be given to the person and their representatives/carers”. These legal powers were open to trusts prior to covid, but the memo from NHSE comes amid increasing pressure on trusts to improve discharge rates, as waits for emergency and elective care continue to soar. Helen Hughes, chief executive of Patient Safety Learning, said: “Given the current pressures posed by covid, it is understandable that the NHS is seeking to ensure that the hospital discharge process is as swift and effective as possible. “However, hospital discharges are complex processes and can potentially result in avoidable harm if patients are discharged before they are clinically ready. It only takes one element of this complex process failing to put a patient’s safety at risk. “We would be particularly concerned if patients and their carers were put under pressure to accept potentially unsafe discharge options due to the threat of possible legal action by an NHS trust.” Read full story (paywalled) Source: HSJ, 14 January 2022
  8. News Article
    Hospitals across Kent, Sussex and Surrey are being asked to discharge hundreds of patients who are well enough to leave by Friday. The head of NHS South East, Anne Eden, said the beds are needed to deal with an expected surge in admissions of people ill with the Omicron variant. The NHS nationally has agreed to a reduction of 30% of such patients based on the baseline figure of 13 December. South East hospitals are being asked to make a 50% reduction by 31 January. In a letter seen by the BBC, Ms Eden said: "This is in order to create the headroom to manage any further Covid pressures, with current modelling indicating a peak in Covid activity in mid-January." She wrote: "It is now critical that we redouble our efforts to discharge those patients who no longer require bedded care, to create capacity, improve flow and reduce the pressure on staff." Ms Eden said staff absences and the need to maintain delivery of critical care for patients mean the NHS "must continue to focus on creating the necessary capacity to meet demand". "Failure to do this will significantly increase the risk of a further rise in patient harm," she said. She said hospitals must work with partners, including social care providers, to achieve the reduction in the number of patients in hospital who were well enough to be discharged. Read full story Source: BBC News, 10 January 2022
  9. News Article
    NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave. The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds. This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients. The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”. Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111. Read full story (paywalled) Source: HSJ, 7 January 2022
  10. News Article
    A care home with some of the highest Covid death rates recorded in the pandemic is facing whistleblower claims over unsafe conditions. Golfhill Nursing Home, in Dennistoun in Glasgow's East End, Scotland, is run by Advinia Healthcare, which confirmed a "large scale" investigation was taking place. A report by the Crown Office, published in April, showed Golfhill care home recorded 11 deaths related to coronavirus, among the highest rates. The Care Inspectorate investigation is said to have followed "months of complaints" about sub-standard and unsafe conditions at the home, including residents being admitted to hospital suffering from dehydration. The problems are said to centre on the intermediate care unit, where elderly residents are transferred after being discharged from hospital, requiring a higher level of care and remaining there for around a month before being sent home or into long-term care. According to a source, the unit has been short staffed "almost on a daily basis" because employees were being transferred to other areas of the home. Read full story Source: The Scotsman, 17 December 2021
  11. Content Article
    The overarching objective of the national Adoption and Spread Safety Improvement Programme (A&S-SIP) is to identify and support the spread and adoption of effective and safe evidence-based interventions and practice. Each of the four objectives of this programme intend to make medical procedures, and discharges from acute settings, as safe as possible whilst driving forward innovation within healthcare. Learn how the programme is being delivered locally by the West of England Patient Safety Collaborative.
  12. Content Article
    This report published by Carers UK looks at carers’ recent experiences of hospital discharge under the discharge to assess model. It reveals the devastating toll on carers where it is clear that they have been left with unacceptable levels of caring responsibilities which are unsafe in some situations. This has placed intolerable stress upon carers and has had negative outcomes for people needing care and support. A very clear thread from carers’ experiences shows that carers have not been involved, consulted or given the right information in order to care safely and well. If carers are considered to be partners in care, then, like health and care professionals, they need access to relevant information to help them support a person needing care safely.
  13. News Article
    Nursing shortages are allowing “profiteering” staffing agencies to triple their rates, care leaders have warned, raising the risk of vulnerable patients being forced to move care homes and increasing the burden on the NHS. The crisis is forcing some nursing homes to become standard residential care homes without support for people with chronic diseases. The shortage also makes it harder for NHS hospitals to discharge patients. Some hospitals have redeployed their own staff into nursing homes to free beds in hospitals. In other places, NHS trusts are competing for staff with care providers. Geoff Butcher, director of Blackadder Corporation, which runs six homes in the West Midlands, said that he paid nurses about £19.50 an hour, slightly higher than the NHS rate of £16.52. “Two of our nurses resigned recently and they’ve gone to an agency for £35 an hour,” he said. “And that agency then came to us and said we can have these staff back at £52 an hour. They want £95 an hour for those nurses on a bank holiday nightshift. It’s utterly unaffordable. “Because the NHS can’t recruit they are having to use these agencies as well. So the NHS is bidding against us, therefore they’re pushing the rates up, and the whole thing has gone into a completely crazy spiral. The agencies are just grossly profiteering out of it." Read full story Source: The Guardian, 14 November 2021
  14. Content Article
    Medication errors are common at the hospital discharge transition but there’s a lot we can do to improve this. The Royal College of Physicians have developed resource focusing on medication safety at hospital discharge that takes teams through the quality improvement process step-by-step. The project was developed in close consultation with a multidisciplinary task and finish group and with input from across health and social care, including patient and carer representatives. This enabled a better understanding of problems that cross sector boundaries, such as medication safety at the hospital discharge transition, and ensured the problem was approached from multiple perspectives.  The guide and accompanying improvement tool templates are available to download below.
  15. Content Article
    This article examines the challenges in regulating patient safety during hospital discharges in England through the lens of liminality. In addition, this article proposes that by positioning the new role of Patient Safety Commissioner (PSC) as that of a ‘Representative of Order’, it could be a means by which this poorly regulated space could be navigated more successfully.
  16. News Article
    Government plans to cut off funding for hospital discharge at the end of March will slow down the NHS recovery of planned care, and threatens ‘distress’ for families asked to quickly take over patients’ care. Since the pandemic began the Department of Health and Social Care has funded measures to smooth discharge from hospital, to help free up capacity. From September last year this was via a £588m national pot for up to six weeks’ funded care and support after discharge. But a letter from NHS England director of community health Matthew Winn last week confirmed the funding will cease at the end of March, with local NHS organisations or councils liable for the continued funding of discharge packages in the 2021-22 financial year. Jennifer Burns, president of the British Geriatrics Society (BGS), which has previously written to the government to urge an extension of the scheme, told HSJ: “The BGS is incredibly concerned… The disappearance of funding for care in the six-week period after discharge creates a cliff edge in the very near future. We urge the government to reconsider this decision and commit to recurrent discharge funding in the upcoming Budget.” Miriam Deakin, NHS Providers director of policy and strategy, said the government’s funding had “played a crucial role in freeing up hospital beds [and] managing capacity”, despite the delays caused by other parts of the system during the coronavirus winter surge. Ms Deakin warned: “Trust leaders are keen to see this funding continue in the longer term. This new way of working does not come without a financial cost, particularly for community services and their staff who are now much more thinly stretched, supporting patients with a wider range of more complex needs at home and in other community settings. We would therefore urge government to continue discharge to assess funding from April 2021.” Read full story (paywalled) Source: HSJ, 18 February 2021
  17. Content Article
    The Patient Safety Authority has put together information and tips for patients on a range of topics.
  18. Content Article
    This survey looks at the experiences of people who stayed at least one night in hospital as an inpatient. People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2021 and were aged 16 years or over at the time of their stay.
  19. Content Article
    On 23 September, Improvement Cymru, the all-Wales Improvement service for NHS Wales, hosted an online session with colleagues from Holland to talk about patient flow in hospital. 
  20. Content Article
    This comprehensive guide from the Social Care Institute of Excellence, discusses the lessons learned from hospital discharge and avoidance during the COVID-19 pandemic. It highlights challenges faced and good practice to prevent unnecessary admissions going forward.
  21. News Article
    Trusts in more than half English local authorities still do not have an agreed safe place to discharge recovering covid patients to, despite the government asking councils to identify at least one such ‘designated setting’ by the end of October. The situation is leading to an increase in delayed discharges from hospital just as the service comes under increased pressure from the second covid wave and returning elective and emergency demand. In a letter last month, the government told local authorities to identify at least one “designated setting” – typically a care home – which hospitals could discharge covid positive patients to when they no longer need secondary care. The designated setting would also take discharged patients who had not received a negative covid test. The plan is designed to protect residents in other homes, after thousands of care home residents died due to outbreaks of the virus in the spring. But a well-placed source in the care sector told HSJ less than half of the 151 upper tier councils met the 31 October deadline, due to a range of reasons including insurance costs, fear of high mortality rates and reputational damage to the designated homes. It means that in many parts of the country, there are a lack of options when it comes to discharging patients, which is causing a rise in delayed discharges. Read full story (paywalled) Source: HSJ, 5 November 2020
  22. News Article
    Delays in discharging patients from hospitals is making pressure on the NHS from the second wave of coronavirus worse, hospital chiefs have warned. Some hospitals are already reporting almost all of their beds are full with patients as the number of coronavirus cases continues to surge with more patients needing hospital care every day. Doctors have told The Independent the lack of discharges means fewer beds are free and some hospitals are seeing long waits in A&E for beds to become available. NHS Providers chief executive Chris Hopson said: “Some of our chief executives are saying they are seeing bed occupancy levels of 92, 93, 94 per cent at the end of October when they would normally expect these to be 86, 87, 88 per cent. “Given where we are in terms of the winter cycle, and the fact we are not really at the beginning of winter yet, that is a worry." “There are much higher bed occupancy levels now than you would normally expect to see at this time of the year.” Without enough spare beds, hospitals will not be able to go ahead with planned surgeries and will have to make patients wait longer for a bed in accident and emergency departments. Read full story Source: The Independent, 30 October 2020
  23. News Article
    The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy. During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis. The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies. As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease. There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus. Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met. Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home. There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites. Read full story Source: The Independent, 27 0ctober 2020
  24. Content Article
    A new report from Healthwatch and the British Red Cross looks at how well the new hospital discharge policy is working for patients, carers and healthcare professionals. In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who may need out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital.  How has the new policy affected people's experience of leaving hospital? Healthwatch and the British Red Cross spoke to over 500 patients and carers and conducted 47 in-depth interviews with health and care professionals involved in the hospital discharge process.  The research shows significant numbers of people are not receiving follow-up support after being discharged from hospital under new policy, leading to unmet needs. 
  25. News Article
    Almost half of hospital patients have been discharged without receiving the results of their coronavirus test – including some patients who were sent to care homes, new research from Healthwatch and British Cross has revealed. Independent national patient body Healthwatch England said it had learned many patients were discharged from hospitals between March and August this year without proper assessments with many vulnerable people sent home without medication, equipment or the care they needed. At the start of the pandemic thousands of patients were discharged to care homes as NHS England instructed hospitals to free up 15,000 beds ahead of the first wave of coronavirus. Approximately 25,000 patients were sent to care homes with some not tested, sparking fears this helped seed care homes with the virus. There have been around 16,000 care home deaths linked to COVID-19. According to a survey of almost 600 discharged patients and interviews with 60 NHS staff, Healthwatch England said it had found serious flaws with the way hospitals had followed NHS England’s instructions. Read full story Source: The Independent, 24 October 2020
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