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Found 167 results
  1. News Article
    Hospitals are sending frail, vulnerable patients home before they are better and without vital medical care, leaving them unable to fend for themselves. Over the past fortnight, The Mail on Sunday has received an alarming number of letters from readers who have told of their anger, frustration and sheer desperation at being denied support they were promised. Many have been left bed-bound and unable to wash, dress or use the bathroom for weeks on end. The daughter of an 87-year-old stroke survivor had to put a hospital bed in her living room and provide 24/7 care for her mother after the local health team failed to provide adequate support. Within a year, the woman was dead, having been treated with little more than paracetamol. In another case, a 70-year-old woman had to take her immobile 84-year-old husband to the hospital in a taxi every day for several weeks to have vital injections, because carers refused to come to their home. And the disabled wife of one 74-year-old man, who fell off a roof and broke his pelvis and ribs, told of the heartbreak at not being able to look after her husband due to her own poor health. Campaigners say a Government scheme designed address the ‘problem’ of bed-blockers – the somewhat derogatory term used to describe patients, most of them elderly, who are occupying a hospital bed that they don’t strictly need – is to blame. The protocol, called Discharge To Assess, launched eight years ago, aims to get patients home as quickly as possible amid reports that some elderly patients ended up stuck in wards for months on end – usually because the NHS hasn’t been able to organise the next stage of their care, so it’s not safe discharge them. Read full story Source: Mail Online, 2 September 2023
  2. Content Article
    Delayed discharges, where a patient is medically fit to leave hospital but is not discharged, were a particular problem in England in the winter of 2022/23. In this article, Camille Oung from the Nuffield Trust highlights some possible solutions to help better prepare health and care services for discharge pressures next winter.
  3. News Article
    Fourteen patients with autism or learning disabilities have died since 2015 while detained in psychiatric facilities in Scotland, figures reveal. The statistics were released for the first time by Public Health Scotland (PHS) following a parliamentary question by Scottish Conservative MSP Alexander Burnett, who has campaigned to end the “national scandal” of otherwise healthy people being locked up for months or years due to a lack of community-based support. The PHS report does not detail the causes of death, but does show that seven of the deaths occurred in patients who had been resident at an inpatient psychiatric facility for between 91 and 365 days, with six (43%) in patients whose stay had exceeded at least one year. Rob Holland, acting director of the National Autistic Society Scotland, said the data was a “step forward in understanding the experience of autistic people and people with a learning disability within inpatient psychiatric facilities”. He added: “While it does not shine a light on the reasons for the deaths it does highlight how almost all of those that died had been within institutional care for more than 30 days with 6 people having been there for more than a year. “Hospitals are not homes and it adds further impetus to the Scottish Government’s ‘Coming Home’ strategy to reduce delayed discharge and support people to live in homes of their own choosing.” Read full story Source: The Herald, 18 May 2022
  4. News Article
    A chief executive has described her ‘considerable regret’ that growing difficulty in discharging patients has resulted in nearly half of her trust’s inpatients being clinically ready to leave. Debbie Richards, who leads Cornwall Partnership Foundation Trust, a community and mental health provider, highlighted the issue at the trust’s board meeting last month, amid a “dearth of adult social care provision” across the country. In her update to the board, Ms Richards said delays in finding onward care for patients awaiting discharge meant “almost 50 per cent of our community hospital beds are occupied by patients who have no medical need to be in hospital”. In her report to the board, Ms Richards said: “Despite having over 5,000 care home beds in Cornwall, the majority of these are full, or care home providers are unable to offer beds because of a lack of staffing. “Where there is capacity, this tends to be for lower-level residential beds where unfortunately there is much less demand.” Siobhan Melia, chair of the NHS Community Network and CEO of Sussex Community FT, said the “dearth of adult social care provision” was the biggest limiting factor in discharging delayed patients home, followed by high staff vacancies and sickness absence." She called for a national long-term funding settlement for social care and reform of the sector to address the key challenges. Read full story (paywalled) Source: HSJ, 10 May 2022
  5. News Article
    Government policies on discharging untested patients from hospital to care homes in England at the start of the Covid pandemic have been ruled unlawful by the High Court. The ruling comes after two women took former Health Secretary Matt Hancock and Public Health England to court. Dr Cathy Gardner and Fay Harris said it had caused a "shocking death toll". Prime Minister Boris Johnson renewed his apologies for all those who lost loved ones during the pandemic. Dr Gardner and Ms Harris partially succeeded in claims against Mr Hancock and Public Health England. The women claimed key policies of discharging patients from hospitals into care homes were implemented with no testing and no suitable isolation arrangements in the homes. A barrister representing Dr Gardner and Ms Harris told the court at a hearing in March that more than 20,000 elderly or disabled care home residents died from Covid between March and June 2020 in England and Wales. Jason Coppel QC also said in a written case outline for the judicial review that the care home population was known to be "uniquely vulnerable" to Covid. "The government's failure to protect it, and positive steps taken by the government which introduced Covid-19 infection into care homes, represent one of the most egregious and devastating policy failures in the modern era," he added. Read full story Source: BBC News, 27 April 2022
  6. News Article
    Two national reviews are taking place into hospital discharge policy, it has emerged, amid major changes to funding and legislation. One review, led by the Department of Health and Social Care, is developing discharge policy for once the Health and Care Bill comes into force; and a second is reviewing the “clinical criteria to reside”. Delayed discharge has been a major problem in the acute and emergency care system this winter, with the number of long-staying patients significantly up on previous years. It has been blamed for long patient waits for ambulances, to get into emergency departments, and to be admitted; and for interrupting elective care recovery. An NHSE letter confirmed that the government’s national “discharge taskforce” was developing “best practice in improving discharge processes and addressing barriers to timely discharge”, in preparation for the new system. It went on: “This includes improving hospital processes to support discharge; minimising delays in the transfer of care from an acute hospital on to follow-up care services; minimising long lengths of stay in rehabilitation at home or in bedded care and ensuring social care services are available at the right time for people with ongoing care requirements. Further resources and support will be shared as learning from these systems becomes clear.” Read full story (paywalled) Source: HSJ, 28 March 2022
  7. 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
  8. 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
  9. News Article
    A trust has had to re-examine the cases of more than 31,000 patients after they were automatically and wrongly discharged from its care because they did not have another appointment within the next six months. Dartford and Gravesham Trust in Kent has revealed that soaring waiting times post-covid meant patients who needed follow-up appointments were not offered them within six months, which before covid was a very unusual occurrence. When they passed six months, they were dropped off waiting lists altogether, due to a feature in the trust’s patient administration system designed to ensure outdated pathways are closed. It is a common feature in many such systems, HSJ was told. The trust has now “validated” more than 31,000 patients who have been in contact with it since 1 September 2021. So far, it said, it had not found evidence of harm, although some people have been recalled for clinical review or investigation, and a small number are still to be seen. Read full story (paywalled) Source: HSJ, 22 August 2023
  10. News Article
    A struggling trust has been warned by regulators that it could see its junior doctors removed, after concerns about clinical supervision and safety at a hospital whose A&E closes at night. NHS England inspectors who visited Cheltenham General Hospital found emergency patients – including potential surgical patients – became the responsibility of the overnight medical team when its accident and emergency closed in the evening. One night, 26 patients had been handed across, the inspectors were told, and some patients were felt to be inappropriate for medical referral. A surgical registrar could be telephoned at Gloucester Royal Hospital about surgical patients. They were told that although there were no incidents of serious harm, there had been many “near misses” and juniors felt “unsafe and unsupported in terms of consultant clinical supervision, overall clinical/nursing staffing support or logistically in managing patients in this setting or arranging transfers”. Read full story (paywalled) Source: HSJ, 7 July 2023
  11. News Article
    More than half of all serious incidents where patients came to harm involving West Midlands Ambulance Service were due to clinical errors. A trust audit found choking management, cardiac arrests and inappropriate patient discharges as themes. It also noted a decision to close all community ambulance stations was taken without first doing a full risk assessment of the impact on safety. After the number of serious incidents increased from 138 in 2021-22 to 327 in 2022-23, an audit by WMAS found 53% were due to mistakes with their treatment. A situation where a person comes to significant harm in care is identified as a serious clinical incident. Sources say the trust also delayed looking into 5,000 serious patient incidents. Read full story Source: BBC News, 29 June 2023
  12. News Article
    An independent review has raised concerns about a mental health trust’s reporting systems and has highlighted a significant number of patient deaths shortly after leaving the trust’s care, including almost 300 who died on the same day they were discharged. However, the review into how Norfolk and Suffolk Foundation Trust collects, processes and reports mortality data made no conclusions on the number of avoidable deaths – the issue which had originally prompted the probe. Local NHS leaders argued the review’s purpose was focused on auditing the trust’s processes, and this had been delivered. But a local MP, Clive Lewis, accused it of “explicitly dodg[ing] the big questions”. The report, which looked at data from between April 2019 and October 2022, has however raised concerns about the number of patients dying soon after being discharged. Read full story (paywalled) Source: HSJ, 28 June 2023
  13. News Article
    NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned. The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards. The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays. On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays. In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”. Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients. However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E. Read full story Source: The Independent, 4 September 2022
  14. News Article
    Medically fit patients are waiting up to nine months to be discharged from some NHS hospitals as increasing numbers of working age people develop more complex conditions amid ongoing social care shortages, HSJ can reveal. Trust data obtained by HSJ suggests patients at the hospitals which have struggled most with delayed discharges can face delays of many months after a decision has been made that they are fit to leave hospital. HSJ obtained data from seven trusts which have consistently reported high numbers of delayed discharges through a freedom of information request. At North Bristol Trust, one patient waited more than nine months to be discharged, while another waited around eight months. David Maguire, a senior analyst at The King’s Fund think tank, said lengthy delayed discharges often involve patients with highly complex needs, elderly and frail patients, or people with mental health conditions or learning difficulties. But he said there is also a growing number of working age people with chronic and more complex conditions. He added: “There has always been a large number of older people who will access health care and hospital services. But over the last few years we have seen a growing number of working age people requiring hospital care and social care services. That’s a growing part of the demand which will flow through into who needs discharge from hospital settings. Read full story (paywalled) Source: HSJ, 31 August 2022
  15. News Article
    Doctors and health service providers welcomed publication of an NHS strategy for managing demand ahead of another busy winter for health and social care, but said it failed to address underlying problems with the system. In a letter to the heads of NHS trusts and integrated care boards, NHS England chiefs said they had begun planning for capacity and operational resilience in urgent and emergency care ahead of "significant challenges" during the coming months. The British Medical Association (BMA) said the strategy was a "step in the right direction", but "lacks detail", while the Royal College of Emergency Medicine (RCEM) said it amounted to little more than "a crisis mitigation plan". The package of measures included creating the equivalent of 7000 extra general and acute beds through a mix of new physical beds, scaling up 'virtual' beds, and "improvements in discharge and flow". The letter acknowledged that there was "a significant number of patients spending longer in hospital than they need to" and that whilst "the provision of social care falls outside of the NHS’s remit, the health service must ensure patients not requiring onwards care are discharged as soon as they are ready and can access services they may need following a hospital stay." Read full story Source: Medscape, 15 August 2022
  16. News Article
    A senior hospital nurse said she could not discharge 180 patients due to a lack of "care and support" at home. Norfolk and Norwich University Hospital said among the people that did not need to be in hospital was a patient who had been there for 145 days. Claire Fare, senior discharge matron, said delays "impact on the whole of the flow" of patients. Norfolk County Council's social care department blamed the "national care crisis" for the problems. In June, the hospital, which has about 1,200 beds, pleaded for family and friends to help look after fit patients to ease demand. Melanie Syson, the hospital's discharge coordinator, said there was a person in the hospital ready for discharge that had been there for more than four months. "She is medically fit to be discharged but we are waiting for support to be ready at home," she said. Ms Syson added: "The length of stay of the patients seems to be getting longer." To help cope with the delays, the hospital opened a "home-first unit" in January for patients who did not need acute care but it was unable to discharge. The unit focuses on rehabilitation to try to prevent the patients coming back into hospital or requiring more care at home. Stephanie Ward, the ward sister, said it aimed to "give patients the time they need to do things themselves as much as they can". Read full story Source: BBC News, 15 July 2022
  17. News Article
    NHS England’s director of community health has said a new strategy for rehabilitation care is needed, because present coverage is sometimes ‘bizarre’, with other services ‘masquerading’ as rehab. Matthew Winn, who is also Cambridgeshire Community Services Trust CEO and senior responsible officer of the “ageing well” programme in the NHS long-term plan, made the comments in a webinar for local senior clinicians and managers in the sector. He said there was an intention to roll out a national “intermediate care strategy”, describing it as “the essence” of providing rehabilitation and helping hospital patients to “optimise, to recover, to rehab through a skilled multiprofessional team”. They would leave hospital in a “timely pathway” and not need as much social care support afterwards. It comes amid huge pressure to speed up hospital discharge, which often relies on rehab services. Read full story (paywalled) Source: HSJ, 14 July 2022
  18. News Article
    Patients may be turned away at A&E in Portsmouth as the UK’s heatwave drives extreme hospital pressures. Staffing pressures coupled with additional strain from the current heatwave have forced Portsmouth Hospitals University Foundation Trust to declare a critical incident. The trust said it only had space in its emergency department for patients with life-threatening illnesses and critical conditions and so would be forced to redirect other patients elsewhere. In a statement, Portsmouth Hospitals University FT said: “Our emergency department remains full with patients and we have very limited space to treat emergency patients. We are only able to treat patients with life-threatening conditions and injuries, so anyone patients who arrive at ED without a life-threatening condition or injury, will be redirected to alternative services that can help... “Our immediate priority is to ensure there are beds available to admit our most seriously ill patients into and we are focusing on safely discharging as many patients as possible. We ask that families and loved ones support us with this and collect patients as soon as they are ready to be discharged.” Read full story Source: The Independent, 11 July 2022
  19. News Article
    NHS England has set trusts and systems a ‘100-day challenge’ to discharge more patients from hospital and free up beds before winter. David Sloman, chief operating officer of NHSE, has asked leaders of integrated care boards, acute and community trusts in a letter sent last week to adopt 10 “best practice initiatives” which he said “can make a significant difference in facilitating discharge and improving care for patients”. Trusts and systems have been given until 30 September to have a “full understanding” of the initiatives (listed below) and “infrastructure in place” to implement them. The initiatives include setting expected dates of discharge for patients within 48 hours of admission, “apply seven-day working” to discharge more patients at weekends, treat delayed discharge as “a potential harm event” and to manage workforces in community and social care services “to better match predicted patterns in demand”. Sir David has told regional and local leaders that a dedicated national NHSE team will set up “launch meetings” in each system, which will ensure there is “a focus on improving processes and performance around discharge”. Read full story (paywalled) Source: HSJ, 5 July 2022
  20. News Article
    The NHS has a low bed base, and NHS England is reviewing ‘how we right-size our capacity’ across hospital, community and ‘virtual’ services, Amanda Pritchard has said. The NHSE chief executive addressed the annual NHS Confederation this week and said: “The NHS has long had one of the lowest bed bases among comparable health systems. And in many respects this reflects on our efficiency and our drives to deliver better care in the community. “But it was true before the pandemic, and it remains true now that we have passed the point at which that efficiency actually becomes inefficient. “So the point has come where we need to review how we right-size our capacity across the NHS. That will of course look at the whole picture of hospital, community and virtual capacity.” Ms Pritchard also highlighted the current pressures on the emergency care system, which has widely been linked to slow discharges from hospital and insufficient social care provision. She cited the “unacceptable rise in 12-hour waits for admission from [accident and emergency]” which “underlines that the issue is flow”, and said “we know we will need to make more progress before winter”. Read full story (paywalled) Source: HSJ, 15 June 2022
  21. News Article
    The number of patients stuck in hospitals despite being ‘medically fit’ to leave has continued to increase in recent months, leading to warnings from NHS Confederation that trusts are finding it ‘impossible’ to make progress on reducing the numbers. Official statistics for April suggest an average of 12,589 patients per day in NHS hospitals in England – 13% of all occupied beds – did not meet the “criteria to reside”. At 31 trusts, the proportion was 20% or more. NHS England has since told local leaders to make reducing the numbers of delayed discharges an operational priority. The issue is a key factor behind the long waits in emergency care, as ward beds are taking longer to become available to accident and emergency patients. Rory Deighton, acute lead at NHS Confederation, said targets to reduce delayed discharges “will not be met” unless the government “invests in domiciliary care wages,” amid high numbers of vacancies in the social care sector. Read full story (paywalled) Source: HSJ, 1 June 2022
  22. News Article
    A new scheme in Wales to help people who have suffered falls has prevented 50 ambulances being unnecessarily sent this year. St John Ambulance works with Hywel Dda health board in Pembrokeshire to send its people when someone calls 999. The pilot has been used 96 times since January but it needs more health board funding to continue after March. Ageing Well in Wales estimates that between 230,000 and 460,000 over 60s fall each year. When people dial 999, it can be directed to the St John Ambulance falls response team, who are sent to perform an assessment and identify whether the person can stay home or needs an ambulance to take them to hospital. St John Ambulance operational team leader Robert James said in 60% of cases, the person was well enough to stay at home. "You can imagine if you were sending an ambulance crew out and it has wasted 60% of the crew's time, well it's a big saving towards the NHS and the ambulance service in itself," he added. "Provided there are no injuries, or reason for them to go to hospital, they can be discharged on the scene." Read full story Source: BBC News, 10 March 2023
  23. News Article
    Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals. The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community. Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans. In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital. Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed. The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.” Read full story (paywalled) Source: HSJ, 22 February 2023
  24. News Article
    "It would be much better if I was out there than in here," said Roger. The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital in Wales. He has been here for three weeks after being admitted with an infection and although he is now well enough to leave, and desperate to do so, he can't. Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home. Roger is not alone. "At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital. "It is very much a waiting game for that care to be available," she said. Hospitals in Wales are fuller than ever, according to the latest statistics. In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded. Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital. "Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said. Read full story Source: BBC News, 16 February 2023
  25. News Article
    A high-profile £250m government intervention to free up hospital beds has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases. Steve Barclay announced the fund, including £200m to buy step-down residential care beds to speed up discharges, on 9 January, following a “recovery forum” crisis summit at 10 Downing Street. NHS England said in guidance on 13 January the funding must bring “immediate improvements”, and local leaders were again told to “maximise the impact of their areas’ allocation of the money in the run up to strikes on 6 February”. But according to official data, in the week the new money was announced, there was an average of 14,035 patients who did not meet the clinical “criteria to reside”, but were still waiting to leave hospital, equating to around one in seven occupied beds. The total numbers have barely changed since then, with an average of 13,975 cases reported in the week to 5 February, also representing one in seven occupied beds. Read full story (paywalled) Source: HSJ, 13 February 2023
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