The vexed problem of properly discharging elderly patients from hospital back into the community

By John Tingle

The National Health Service (NHS) just does not seem to be able to deal properly with discharging elderly patients from hospital back into the community. There have been major issues in this area going back decades. Stories in the media and official reports regularly appear about ‘bed blocking’ by elderly patients or hospitals discharging them back into the community without proper care arrangements being made.

There is a real fear that the NHS will never be able to turn things around here and that the lessons of the past are not being learnt .There are seemingly intractable problems being faced by trusts, social services and others in doing a proper job with elderly patient discharge.The high financial cost to the NHS of keeping well elderly patients in hospital has also been widely discussed.

Hospitals and social services have faced a barrage of criticism of failing to have coordinated care policies and arrangements leading in some cases to deaths of patients.
Two reports have been published recently which show that patient safety is being seriously compromised in this area.

The Parliamentary and Health Service Ombudsman (PHSO) has published a report of investigations into unsafe discharge from hospital.The National Audit Office (NAO) have also published a report in this area, discharging older patients from hospitals.

Both reports reveal some hard hitting failures in discharge arrangements for the elderly and there are many questions to be asked and lessons learnt from these reports.

In 2014-15 the PHSO investigated 221 complaints on failure to manage discharge properly; an increase of over a third in complaints in the previous year. In 2014-15 across the NHS there were 6,286 complaints on admissions, discharge, and transfer arrangements. This was a 6.3% increase on the previous year.
The PHSO talks about in the report  the untold anguish such poor discharge arrangements can have on families and carers. Tragically some of the patients in the case reports died because of poor discharge planning and their families wish to know what has been learnt from their poor experiences and what will happen next to make things better for future patients.

The National Audit Office (NAO) scrutinises public spending for Parliament. Parliament can then hold government to account for its spending and organisation of services. This will hopefully lead to more efficient and improved public services such as health care.

The NAO state that there are currently far too many older people in hospitals who do not need to be there. Urgent and radical action needs to be taken as the problem will worsen and there will further financial strain to the NHS and local government. The NAO state that health and social care system’s management of discharging older patients from hospital does not represent value for money. They estimate that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.

Both reports provide very interesting perspectives on an old and well documented issue which continues to be and threatens to become even more pressing as our population grows older.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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