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On hospital discharge

When discharge goes wrong, it comes at significant cost, both to individuals and to the health and social care system.

Whilst the financial cost of this problem is recognised, not enough is known about the human cost. We undertook this inquiry to bring the true emotional and physical impact of this persisting problem to light. With the help of 101 local Healthwatch, we heard from over 3,000 people who shared their stories with us about their experiences of the discharge process.

Throughout this inquiry, we focused on the experiences of older people, homeless people, and people with mental health conditions – three groups for whom the consequences of a failed discharge process were particularly detrimental. Hear about their experiences, as reported on Channel 4.

We found that there are five core reasons people feel their departure was not handled properly. 

A big thank you to all those on our Special Inquiry team and advisory panel and to all the other organisations that contributed.

People experience delays and a lack of coordination between different services

Homeless people, older people and people with mental health conditions told us about problems they experienced as a result of poor coordination between different parts of the health system, and between health services and community support.


We heard about:

  • disputes between local authorities about who would pay, resulting in assessments not taking place.
  • delays with assesments for ongoing care needs
  • patients being detained unnecessarily in mental health settings when they posed no risk to others.
  • delays while care coordinators and social workers try to get funding for ongoing support in the community

People also told us that information is not always being passed onto their GPs as quickly as it should be, leading to delays in receiving aftercare treatment, or medication once they return back to the community.

An estimated one in 20 bed days are used by people experiencing a delayed discharge in a mental health setting

Jess’s experience:

Detained under the Mental Health Act in a low secure unit, Jess had been assessed as fit for discharge. However, an agreement could not be reached about the funding of her care and accommodation in the community.

The delay in her discharge was causing significant distress as she was away from her young daughter.

Jess went through a multitude of routes to try and resolve these funding issues. She contacted her ‘home team’ (from whom she had not received any correspondence for over a year) and instructed a solicitor who applied to the Mental Health Tribunal. She remained in hospital throughout this time.

The authorities finally reached an agreement and Jess has moved into her new home. She now has contact visits with her daughter, who lives with a family member. She is still waiting for discharge from her residency order as she cannot access legal aid and cannot afford to fund court costs herself.

People feel left without the services and support they need after discharge

People shared numerous examples of being left without the support they needed post-discharge, leaving them in very vulnerable situations and often leading to readmission.


We heard about:

  • people contacting out-of-hours mental health crisis support services only to receive no response or to be told to call back later
  • nobody following-up with patients, leaving them not knowing where to turn for support and, in some cases, having to arrange their own aftercare
  • homeless people being discharged straight back to the street without accommodation in which to recover
  • older people experiencing additional falls leading to extensive readmissions which could have been avoided

 

Shaz’s experience:

With a known history of self-harm, Shaz was discharged from hospital, armed with only the phone number of the crisis mental health team.

Following suicidal thoughts, she rang the crisis team that evening but they were not available. She also contacted her out-of-hours GP services, which were unable to see her that night.

Distraught, she walked to her local pharmacy to buy medication. The pharmacist recognised her and, worried about what she might use the medication for, refused to serve her.

Shaz told the pharmacist that she felt she was in crisis and concerned that she might harm herself. He gave her a phone to call NHS 111, who told her to go to the Accident and Emergency (A&E) department of the hospital she had been discharged from that day.

Following an assessment by an A&E nurse, Shaz was told it was fine for her to go home. The next day she visited a different pharmacist, took an overdose and was taken by ambulance to the A&E department she been discharged from the night before.

People feel stigmatized and that they are not treated with appropriate respect

We heard how all three groups felt that they experienced stigma and the impact that perceived staff attitudes had on their treatment and interactions.


We heard about:

  • homeless people feeling judged by health workers and not treated with kindness or respect during their stay 
  • patients feeling unwanted in hospital and perceiving that they were discharged too early as a result of this stigma
  • those who had been hospitalised due to self-harming or suicidal behaviours hearing healthcare workers ‘tutting’, or making unkind comments about being ‘a waste of hospital beds’
  • the indignity with which older people are treated when being discharged, leaving people very vulnerable

“They are never nice to me. They are not gentle when they treat me and put the needle in my arm for the drip to help me get hydrated. I am not a drug addict. They should talk to me differently but instead they say things like ‘get out drug addict, go and get a job’.

“I felt I was in an emotional maze internally and externally… when I arrived to the hospital a nurse told me how much I was costing the NHS. I felt more guilty and suicidal.”

“I rang shortly after lunch to be told [Mum] had been discharged. I was shocked. She lived alone and was still delusional. A neighbour rang to say mum had been brought home by ambulance in her nightgown and left at the cold house after the driver got a key from another neighbour. The elderly neighbour stayed with her all night. She was readmitted the next morning.”

 

People don't feel involved in decisions about their care or given the information they need

People told us that they were not consulted about their care or discharge needs, and that parents and carers had not been communicated with about their relatives’ conditions and support needs.


We heard about:

  • people being sent home despite raising concerns about their ability to cope
  • homeless people felt rushed through hospital and sent back to the streets without being advised where they might seek further support to recover or manage their condition
  • families and carers reported not being given enough time to prepare for someone’s return home, or enough information to understand what they need
  • discussions about people’s conditions and care plans being confusing
  • how this lack of involvement amongst patients and their families about their conditions and support requirements can lead to terrible consequences

 

 

John and Anne's expeirence:

John suffered with sever episodes of depression and anxiety. 

While having some building work done at home, his condition intensified and his wife Anne discovered him engaging in suicidal behaviour. She took John to hospital where he was voluntarily admitted.

A few days later, Anne received a text telling her to collect John from the hospital. She was told John would be leaving with medication and she would need to provide him with additional support.

John was agitated and did not want to return home, but the hospital rejected his request to stay. He asked if he would be able to return if he felt unable to cope at home but the hospital said no and discharged him with an appointment for further assessment a week later.

One evening the following week John said he was going to visit a friend and did not return home. Anne contacted the police who told her that he had committed suicide.

People feel that their full range of needs is not considered

We heard about the frustration people feel that organisations deal with the problem people present, rather than their full range of needs


We heard about:

  • people’s physical and mental health, housing, care responsibilities and financial situation not all being taken into consideration
  • how, in many cases, homeless people experience mental health as well as physical health problems, as do older people - the three groups we focused on are not mutually exclusive
  • people being discharged without sufficient treatment and support for their full range of needs, often resulting in conditions worsening and readmissions
  • a series of missed opportunities to address the full extent of people’s needs and support them to recover in the long term

"My previous admissions and medical history were not discussed. I would have liked more support, such as advice about support services within the community. I would have liked a more joined up approach, not the feeling of being rushed so that I could be discharged as soon as possible without any serious consideration about my needs."

Evelyn’s story:

As a carer for her 85 year old husband who has dementia, Evelyn had to make plans for his care while she was in hospital. A few days after her operation a student social worker told her: “You can’t have a care plan. There aren’t any carers. I haven’t been able to fix anything, not even for you to pay for. I’ll keep trying.”

Evelyn didn’t know how she would cope. Her husband also has Reynard’s disease which affects his hands and means he cannot grip and would be quite unable to help with Evelyn’s personal care, or with meals.

Evelyn said: “[The ambulance drivers] left me standing in my kitchen supported by two crutches. I am no wimp but on that afternoon I was devastated. I had not felt so abandoned since my mother died when I was 25. Even now, several weeks on, I find it difficult to talk about, or even as I write, without crying.”

Download our report

We heard from over 3,000 people who shared their stories with us about their experiences of the discharge process.