What happens when people leave hospital and other care settings?
Findings from the Healthwatch network
Thousands of people treated in hospital every year are kept in longer than medically necessary because of administrative delays or a lack of available care in the community.
This causes unnecessary distress for patients and places additional strain on the NHS.
Yet tackling the underlying reasons for the delays, whilst also ensuring every patient has a positive and safe experience of being transferred between services, is not straightforward. To find out more, the Healthwatch network collected and reviewed 3,200 people’s experiences of leaving hospitals and other health and care settings in 2015.
We focused specifically on people in vulnerable circumstances, including older people, patients with no home to go to, and those with mental health conditions. The stories shared with us highlighted both the human and financial impact when discharge goes wrong.
Although the evidence was hard to hear at times, our Safely Home report played an important role in galvanising much needed system-wide leadership. Since publication we have seen encouraging changes at both a national and local level.
However, with a rising population of elderly people, and the cost of care going up it’s not surprising that key indicators of poor patient experience such as the numbers of delayed transfers of care have hit record levels.
To help assess progress from the patient perspective two years on from Safely home, this briefing brings together what 46 local Healthwatch have heard from over 2,000 people about the discharge process since.
Whilst we have heard numerous positive stories about people’s experiences transferring between hospitals and care in the community, it is clear that there is still significant work to be done to ensure discharge is a good experience for everyone. In particular:
• People still don’t feel involved in decisions or that they have been given the information they need.
• People continue to experience delays and a lack of co-ordination between services, highlighting specific problems with being given medication and transport services.
• People feel left without the services and support they need after being discharged.
We explore these points further in this briefing and highlight where local Healthwatch have been working with partners across health and social care to make changes. If adopted more broadly, these examples have the potential to improve people’s individual experiences and ease some of the broader pressures on the NHS.
We also explore the need to carefully evaluate the introduction of such initiatives, in particular the new target to reduce delayed discharges set out in the Mandate to NHS England, to ensure they are having the right impact.
Finally, this briefing seeks to outline how the move towards greater integration of services provides a perfect platform from which to fix the discharge problem once and for all.