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Your spotlight on health and social care services
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Co-ordination

People told us that they had to stay in hospital longer than necessary because services didn't work effectively together. Some people had to wait longer than expected for their medication, while others had to wait for transport to take them home.

ambulance

Transport

People said they often experienced delays with patient transport services, leaving them distressed, confused and having to stay in hospital longer than necessary.

Two patients Healthwatch Middlesborough spoke to said they’d been told they were fit to go home but had been forced to spend an extra night in hospital because of a lack of transport. Another patient was very disappointed because she’d been told by the driver who brought her into hospital that there would definitely be transport available in the evening to take her home again. However, when the evening came around, she was told that she wouldn’t be able to go home until the next morning because it was too late to arrange transport.

Not only was this a waste of hospital resources but because the patient hadn’t been told to pack an overnight bag, she had not come prepared to stay, which caused her unnecessary distress. Healthwatch Middlesbrough told the hospital trust what they'd heard, which then committed to monitoring the effectiveness of their transport service, and explained that, as part of a retendering process, they are exploring having a member of the company’s staff on site to improve the service.


Medication

We heard a lot about people having to wait a long time for their medication before they could be discharged.

Healthwatch Leicestershire (2017) spoke to 216 people who were leaving hospital between September and December 2016. Of those who experienced a delay being discharged, 41% said it was as a result of waiting for medication.

In response, the local hospital trust has adopted the 'Red2Green' programme, designed to help reduce the number of days people spend in hospital unnecessarily. They also said they have started to prepare prescriptions for patients the day before discharge, and reintroduced discharge medication checking stations in wards to ensure that the correct medication is given to people when they leave. 

Healthwatch Middlesbrough found that some people they spoke to waited so long for their medication that they ended up going home without it and then either had to go back to hospital themselves to get it or to ask a family member or friend to go for them.

Discharging patients without their medication isn’t just inconvenient, it can be dangerous and costly. Following Healthwatch Middlesbrough’s report, the hospital has started to introduce dispensing carts in wards to help take pressure off of the pharmacy department and ensure that people are discharged more quickly.


Communication between services

People spoke about poor communication between services, such as hospitals and social care workers, and the detrimental effect this had on their care. As a result, many people did not have care plans in place in time for their discharge, community care staff didn't turn up when expected, and GPs didn't have information about changes to people's prescription medications following their time in hospital.

When Healthwatch Richmond upon Thames raised concerns about this with their local hospital, they were told that their Discharge Governance Group, made up of hospital staff, social services and voluntary sector representatives, had helped to improve communication between providers, and was going to be extended across their other sites.

The group had already worked to create a new discharge checklist and a variety of actions, from improving communication between ward staff and families, to boosting connections between the wards and district nurses, were ongoing.

Healthwatch Gloucestershire recommended in 2015 that local hospitals improve their communication with care homes and social care providers. When they followed up in 2017, they found that things had improved, thanks to great collaboration between a hospital trust, local care homes and other people in the care sector. They also have an ‘Integrated Discharge Team’, which is involved in all discharges that involve care homes.

In some instances, we found that services weren't speaking to each other enough because of a lack of trust between them. For example, Healthwatch Essex heard about health and social care colleagues blaming each other for problems with the discharge process, which exacerbated the issue. One social care worker said that “The discharge team will try and blame us, and in turn, we’ll try and blame other things.” They heard that this could lead to even further delays to care assessments, making the situation worse for patients.

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