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Key findings Most questions on the theme of being treated in a respectful and dignified manner continued a trend of sustained improvement over the last 3-6 years. Results show communication between staff and patients before and after operations is improving. Patients continue to report positively when asked about the cleanliness of the hospital environment, the choice of food available to them and hydration. Confidence in doctors and nurses also remains high this year. However, this year’s results indicate that there are areas in need of improvement: Patients consistently reported less positive experiences for the themes of: communication at the point of discharge and consideration of the support they will need after leaving hospital. Results for information sharing in relation to medicines, including: explaining the purpose, being told about possible side effects and being given written or printed information all declined this year. The percentage of people experiencing shortages in nursing staff remains high. Certain groups of patients consistently reported poorer experiences of their time in hospital, including patients with dementia or Alzheimer’s, younger patients (aged 16 to 35) and patients who were admitted in an emergency.

This study highlights that people with complex concerns with a history of placement breakdowns and past institutionalisation can be settled successfully and safely in local communities. However, it is difficult for many of them to achieve a satisfactory quality of life long term. The obligation for this lies with service providers to provide adequate support to overcome that difficulty.

This is a template that can be used by health professionals carrying out medicines reconciliation.

This is an interview with sepsis survivor Julia, who gives insight into her own personal battle with the condition.

The Norfolk and Norwich University Hospital introduced NNUH at Home in January 2019 as part of a pilot project. NNUH is working in partnership with HomeLink Healthcare to deliver this service, which will benefit patients by supporting them to leave hospital as soon as they are clinically stable. Some clinically selected patients are able to go home to recover for the last few days of their acute episode of care. These patients remain under the care of the hospital and will be supported at home with bespoke care services such as therapy, nursing care, personal care and IV antibiotics. Patients are able to complete the remainder of their care in the comfort of their own homes, with the full support of their medical consultant and the NNUH and HomeLink teams. The NNUH at Home team comprises of nurses, physiotherapists, occupational therapists and Healthcare Support Workers. Patients transferred to the NNUH at Home service will remain under the care of their hospital consultant until they are formally discharged by the hospital to their GP at the end of their agreed length of stay. NNUH at Home will complements existing NHS community services.

The challenge Some patients leaving hospital need advice and support to help them take their medicines correctly and safely. Around 60 per cent of patients have three or more changes made to their medicines during their stay in hospital, and only 10 per cent of older patients are discharged with the same medication they were taking before they went into hospital. In some cases, errors or unintentional changes to a patient’s medication can occur because of miscommunication. This can lead to patients becoming unwell and being readmitted to hospital, causing unnecessary distress to the patient and placing an avoidable burden on NHS resources. It is estimated that 6.5 per cent of emergency admissions are a result of adverse drug reactions, of which it is estimated that 72 per cent are avoidable. Actions taken In 2016, NHS England in Cheshire and Merseyside, in partnership with the Innovation Agency, received funding from NHS England to support the implementation of systems enabling the transfer of care from hospitals to community pharmacies. Soon afterwards, the initiative was adopted nationally by all Academic Health Science Networks and is one of the AHSN Network’s key innovation programmes. A secure digital system enables a hospital’s pharmacy team to inform the patient’s local pharmacy of the patient’s medicines on discharge, so the pharmacist can follow up with advice and services. Impacts Of all referrals from hospitals to community pharmacies through Transfer of Care Around Medicines, around 40 per cent require follow-up action from the pharmacist. It is estimated that for every 10 completed referrals, eight avoidable bed days are saved for the NHS. As of March 2019, Transfer of Care Around Medicines in Cheshire and Merseyside has been implemented in 10 trusts, including 11 hospitals, two mental health trusts and all 635 community pharmacies in the region – the fastest adoption and widest spread of the initiative in any region in England. There have been 14,853 referrals to community pharmacists at March 2019, of which 6,224 have been completed with further actions from the pharmacist, resulting in calculated savings of 5,103 bed days, or £9.5 million, to the NHS as well as improved patient safety and quality of care. Testimonial Una Harding, pharmacist at Day Lewis Pharmacy in Aintree, said: “We now get notifications on our system on a daily basis, it’s a platform we use every day. New discharges or referrals are the first thing you see when you log on. If we see a patient has recently been in hospital we can make a note to speak to them about their medication when they next come in." "Patients now understand we can deliver more for them. There’s a culture now where people are realising that their GP doesn’t always have to be the first port of call. They know now that if they come into the pharmacy we can talk to them about the changes to their medication." "It’s fabulous. Finally we’re getting more information so we can make more clinical decisions without having to hunt for information from different sources.” Hassan Argomandkhah, Chair of Pharmacy Local Professional Network NHS England Cheshire and Merseyside, said: “What started as an idea – we’ve managed to achieve it, and even if we’ve made just one small change in the quality of life of one patient in the past two years it’s been well worth it. None of this would have happened without the dedication of the pharmacists and their teams – whether in NHS England, in the community pharmacies, or in the hospital pharmacy teams – and all the other ancillary staff surrounding them. Without that support and encouragement we wouldn’t have achieved this.”

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