Waltham Forest patients and carers feed into Healthwatch England national report on hospital discharge
A new report launched on Tuesday (21 July) - “Safely Home: What happens when people leave hospital and care settings?” – brings together 3,230 stories and pieces of evidence gathered by 101 local Healthwatch from across the country, including Healthwatch Waltham Forest.
The report identifies a number of common basic failings including hospitals not routinely asking patients if they have a home or safe place to be discharged to, details of new medications not being passed on to GPs and carers, and families not being notified when loved ones are discharged.
Many of the problems stem from organisations failing to think beyond their own direct responsibilities, with discharge plans often not considering patients’ other clinical needs or home environment, including whether or not patients themselves have carer responsibilities.
Over the past two years Healthwatch Waltham Forest has been collecting patient experiences relating to discharge from the local hospital, Whipps Cross.
Jaime Walsh, Healthwatch Manager said, “Although there are many local people who have a positive experience of the discharge process we continue to hear from far too many that don’t. We are particularly concerned about older patients who often don’t feel ready to go home and for whom there is no interim measure or ‘step down’ facility in place.
“Whilst they themselves can often feel rushed out of hospital when beds are needed, family members and carers also report not feeling adequately supported or ready for the additional caring responsibilities and sometimes aren’t even told their parent/partner is being discharged.
“In some instances care packages are not put in place in a timely manner and equipment aides and home adaptions take too long to be completed, leading to safety concerns.
“There are many parts so the health and social care system that must act in a coordinated way to meet the needs of older and vulnerable patients being discharged and prevent readmission.”
FIVE AREAS WHERE THE HEALTH AND SOCIAL CARE SYSTEM IS GETTING DISCHARGE WRONG
Focusing on those most affected by poorly managed discharge processes – those with mental health conditions, older people and homeless people – the Healthwatch England report reveals five ways patients and care users say they are currently being let down by the system. Examples from Waltham Forest are provided below:
- People are experiencing unsafe, delayed or untimely discharge due to lack of coordination between health, social care and community services.
A homeless man in Waltham Forest with mental health illness and a history of substance misuse attended A&E after 2 months of severe weight loss. He was told he had liver failure and then discharged with no GP, onward referral or follow up treatment planned.
- There is a lack of support available for people after discharge, often leading to readmission.
An older patient was discharged whilst still feeling unsteady on her feet with no follow up or additional support put in place at home. Eleven days later she fell at home and broke her ankle, ending up back in hospital. Another older patient fell and was readmitted to hospital within 1 hr of arriving home.
- Many people feel discriminated against or stigmatised during their care, often feeling ‘rushed out the door’.Individuals from the homeless community in Waltham Forest describe being turned away from A&E, being on the receiving end of an attitude of ‘oh its them again, doesn’t matter’ and being ‘treated like an underclass’ when attempting to get care at the hospital. Healthwatch has also heard from a number of older patients who feel ‘pushed out’ of hospital with one 80 year old reporting the first time she heard about her discharge was when staff told her to ‘pack up her bags’ and that the ambulance was coming for her.
- People do not feel involved in decisions about their ongoing care post discharge.
A carer of her 90 year old father with Dementia and other mental health conditions reported being called by social workers to attend a meeting to discuss her fathers care. She said “The agenda was to get him out of hospital was clear but there was no assistance in helping to get the right homecare in place to support him back at home. In the past no homecare had resulted in a prompt readmission”. He had been in hospital 4 times in 3 months.
- Individuals’ full range of needs are not considered when being discharged from hospital or a mental health setting – including their housing situation, carer responsibilities etc.
An older man living in supported accommodation in Waltham Forest was discharged at 4am in his hospital gown. The supported housing unit where he lives were not made aware of his discharge so in the following days officers were not calling on him to check up.
WHAT PEOPLE SAID THEY WANT WHEN THEY ARE DISCHARGED FROM A HOSPITAL OR CARE SETTING:
- To be treated with dignity, compassion and respect.
- For their needs and circumstances to be considered as a whole – not just their presenting symptoms.
- To be involved in decisions about their treatment and discharged.
- To move smoothly from hospital to onward support available in the community.
- To be properly informed about where to go for help after discharge.
LOCAL SCHEMES IN WALTHAM FOREST
In Waltham Forest the Better Care Together Board oversees the integration of Health and Social Care services for local people. One of the newer projects it oversees involves the development of an ‘Integrated Discharge Team’ made up of both health and social care workers, functioning together to ensure patients experience an appropriate and safe discharge, and have timely support and services in place for them once they arrive back at home. This new service encourages joined up and cross organisational working for the benefit of patients and their families.
Metropolitan runs a ‘Home from Hospital’ service that helps people discharged from Whipps Cross Hospital settle back in at home. They can assist with a variety of practical matters and provide the emotional support vital to people living alone and those that feel isolated. Some of the services it provides include: helping with shopping, having a cup of tea and a chat to talk through any anxieties, and helping to register with dial-a-ride and other support services.
British Red Cross ‘Next Steps’ service also works locally to support people being discharged from Whipps Cross Hospital. It’s ‘Support at home’ service provides time-limited support to people after a personal crisis or illness, giving them the confidence and independence to continue with daily life. They help with such matters as collecting prescriptions, preparing light meals and snacks, and carrying out light housework.
Care Navigators in Waltham Forest support discharge from specialist mental health services for 12-18 months, supporting people to attend appointments with GPs and practice nurses, and providing additional contact if people enter a period of crisis.
In addition, numerous local voluntary and community organisations support people in the community with particular health and care needs, supporting them to remain out of hospital.
Jaime Walsh, Healthwatch Manager said, “These projects are a demonstration that the issues around discharge are being recognised and processes are being put in place to ensure improvements going forward.
“We would encourage all patients and their carers to keep Healthwatch informed of their experiences around discharge so we can keep monitoring and feeding back to those with the power to make changes and improvements”.
The full Healthwatch England report can be found below.