Many patients get more sick because hospitals send them home too soon, patient safety group claims

Many do not record if patients have a safe home to return to

More than half of NHS hospitals do not record whether a patient has a safe home to return to before discharging them, according to a new report.

Patient safety group Healthwatch England said that while almost all of the 120 NHS hospitals that responded to a Freedom of Information (FoI) request carried out “discharge checklists”, many did not include a record of whether patients had food, water and heating available at home.

A survey of more than 3,000 patients who contacted 101 local Healthwatch organisations in England had also uncovered numerous cases of elderly or vulnerable patients being sent home too early, or facing long delays because of a shortage of community care services, the group said.

In many cases, patients’ health deteriorated as a result of being sent home early, requiring another hospital admission within days.

Recent evidence from the National Audit Office suggests readmissions to hospital within just 30 days of being discharged cost the NHS £2.4bn a year. While not all of these will be as a result of an early discharge, Healthwatch England said that as many as two thirds of readmitted patients returned to hospital within a week, indicating “a significant problem” with current process at many hospitals.

The group’s FoI also revealed that one in three NHS trusts were not recording whether notes about new medication had been passed on to GPs or carers.

Healthwatch England said that, despite evidence of very good practice at some NHS trusts, a lack of coordination between hospitals and community services, a shortage of out-of-hospital care options, and hospitals not involving patients in decisions about their care were among the core reasons for failures.

Anna Bradley, Chair of Healthwatch England, said: “There is a huge human and financial cost of getting discharge wrong.”

An NHS England spokesperson said: “It’s important patients who are well enough to leave hospital can do so at the earliest opportunity. However, we also need to ensure appropriate care is put in place.”

The Stroke survivor

Lily Roberts, 70, from north London, now cares full-time for her husband Frank, 81. After being admitted to University College Hospital following a stroke, Frank was discharged in a taxi, on a Sunday, without his wife being informed.

Lily said her husband’s condition was still poor, and he was having trouble swallowing. He was readmitted 10 days later.

“He was not ready to come home. They told me they were planning to transfer him by ambulance to another hospital,” she said.

“Instead, while I was waiting for them to give me a time or date, he came home by cab late at night.

“I thought, oh my Lord, what is he doing home? He certainly was not fit.

“The effect on his state of mind has not been good. Bringing him home by an ambulance would have at least made sure he had come indoors and settled down properly.”

A spokesperson for University College Hospitals London NHS Foundation Trust said that Mr Roberts had “responded very well to hospital treatment” and was discharged after being “thoroughly assessed” at the hyper-acute stroke unit.

The hospital said he had received follow-up care from the local team, but was later admitted to another hospital because of a different health condition.

The Parkinson’s patient

Healthwatch England said that while Parkinson’s patient Albert was in hospital waiting to be moved into care, his medication was not given on time and he did not receive adequate help through physiotherapy.

Albert’s daughter said that staff lacked awareness of the specialist care he needed. He was kept in hospital waiting for assessment, and then for a place in a rehabilitation unit. By the time the place became available his mobility had deteriorated so badly they could no longer do anything for him.

Healthwatch England said that his physical health had deteriorated to “a point beyond repair”. Albert has now been moved into a care home, where his health has continued to suffer, to the point that he can no longer walk.

The 'suicidal' patient

After threatening suicide, the police and ambulance were called and took Tom, a young man with severe mental health conditions, to A&E. He was discharged without a coat, in cold weather, and without money or food, Healthwatch England said. The Crisis Team were shocked at his discharge.

After his mother said it would be unsafe for Tom to be left in shared accommodation, it was arranged for him to stay at a crisis house run by a mental health charity. He was asked if he would stay in a hospital and he agreed.

He was seen by his psychiatrist, who arranged a case meeting with the doctor, Crisis Team and family. However, Tom was discharged before this with no consultation and without a treatment plan.

The homeless person

Julie was homeless and staying in temporary accommodation when she spent a night in hospital. She was not asked about her housing situation, and no support or advice was offered when she was discharged, Healthwatch England reported.

Julie said she had not felt well enough to be discharged. She needed medication and physiotherapy but was not offered either. She was not given a care plan and no transport from the hospital was offered. There was no aftercare, so she resorted to self-medication.

Healthwatch England said patients who had been homeless often reported feeling “discriminated against and judged by health workers, and not treated with kindness or respect during their stay”.