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14th June 2013

Unsafe Hospital Discharges

Hospital discharge should be a planned event. The Community Care (Delayed Discharge) Act 2003 aims to ensure that people do not stay in hospital longer than necessary. If the local authority does not assess the person’s needs and arrange any necessary services within a certain amount of time, it has to pay a fine to the hospital or relevant NHS body under this act, with an estimated cost of £260 per day that a patient remains in hospital unnecessarily.

This can generate a certain amount of pressure on Social work and Care Placement teams to enable a quick and efficient discharge. But this does not always mean safe.

Although many hospitals are trying harder to prepare older patients for a safe discharge, it is not difficult to assume that the person will require extra help and supervision during the weeks after hospitalisation. Official NHS figures disclosed that the number of district nurses working in England decreased from 7813 in May 2010 to 6424 in August 2012 - an 18% cut in the service, yet demand for Homecare is rapidly increasing with a 16% increase in providers being registered with the CQC from 2010/11 to 2011/12.

Whilst Homecare providers are all too aware of the pressures within the Health sector, unsafe hospital discharges are becoming an all too familiar- and dangerous - occurrence for Homecare providers.

A number of factors can increase the risk of an unsafe discharge. Equipment provision; such as wheelchairs, hoists, grab rails; Nutritional needs - can they use a kettle, open tins, is there any food in the cupboards? Accommodation issues - access to toilet, can they still use their phone? Medication issues - is it available and correct.  In some cases, older people are not always able to speak up effectively and accurately about needs at home, for a number of reasons, and may themselves overestimate their own abilities post discharge.

If hospital discharge is not completed safely in the first instance then the cost of readmission and a second discharge has a far greater cost - administration costs, the length of time and energy of the hospital teams, social services and also the Homecare provider.

Failure of communication between health and social care are the principle contributing factors to an unsafe discharge and this poor communication can increase the risk of emergency re-admission into hospital.

But are these re-admissions being recorded? Who is gathering this data and looking at these figures?

I would suggest that all Homecare Providers collate and record their own data on unsafe discharges and emergency re-admissions, and share this information with other providers and your local authority.  I would also recommend that Managers of Homecare providers should ask to see their local hospital’s Discharge Policy, which is a public document.

If you experience unsafe discharges, or incomplete or inappropriate referrals, you should record this and report the incident to your local authority through either a Safeguarding Referral or as a Notification of Concern, whichever is appropriate.

Keeping accurate records and feeding this information back to your local authority will hopefully raise awareness of this increasingly common and concerning issue.

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