Are you certain sending patients home early is really ‘working’ Minister?
Eve By Simmons
dmg media (UK)
Health Minister Maria Caulfield last week boasted that ‘timely’ hospital discharges were cutting waiting lists. A deluge of letters from MoS readers sent home and left to cope alone without any proper care tell a different story. We challenge her to read their harrowing stories and ask... FRAIL, elderly patients are stuck in a ‘revolving door’ of hospital treatment, where they are discharged then swiftly readmitted because shockingly poor aftercare leaves them sicker than they were to begin with, experts have warned. The situation stems from an NHS policy launched in 2015, designed to address the problem of bedblockers – the somewhat derogatory term used to describe patients, most of them elderly, who are occupying a hospital bed they don’t strictly need. The protocol, called Discharge To Assess, aims to get patients back home as quickly as possible – even when they have undergone major surgery – so they don’t end up stuck in wards for months on end. Guidelines state that on the day of discharge, a nurse or occupational therapist should visit and assess the patient’s medical needs before drawing up a care plan. But specialists have told The Mail on Sunday that in a ‘significant number’ of cases, this simply isn’t happening. This newspaper’s GP columnist, Dr Ellie Cannon, first raised the alarm last month. Since then we have received a deluge of letters from readers, telling stories of loved ones being turfed out of hospital too soon and sent home with no advice or support in place. In one appalling case, a 90-year-old was abandoned by hospital transport workers outside his house in the freezing cold with no coat, unable to look after himself and with a catheter still inserted. Others, in their late 70s and 80s, have been left alone with seeping wounds or unable to get to the bathroom, and one patient with severe heart problems died within a week of discharge after no one came to check up on her. Local doctors are so despairing at the situation that one admitted he advises vulnerable patients left without a care plan to simply turn up at A&E. He says it is the only way they’ll be looked after enough to stop them deteriorating. ‘More and more patients are calling our surgery in desperate situations. They’re alone, immobile, often unable to climb the stairs to get to the bathroom or unable to stand and make themselves anything to eat or drink, with wounds left undressed, and they don’t know what to do,’ says Dr Dean Eggitt, a GP working in Doncaster. ‘I know there is a terrible problem with bed capacity, but I find myself telling people what to say to emergency doctors to get a bed, even if they don’t have an urgent medical problem. I know that the alternative is they are left to deteriorate because there’s no one to feed, clothe or look out for them.’ Professor June Andrews, a former nurse and expert in the care of older people, adds: ‘I tell famiare lies to start preparing their own care plan as soon as a loved one is admitted [to hospital], so things are in place when they come home. You just can’t always rely on the NHS to offer care any longer.’ THE warnings come in the same week that Health Minister Maria Caulfield declared NHS discharge policies were ‘now working’. The MP for Lewes told BBC Radio Four’s Today Programme on Wednesday: ‘We’re creating 2,000 extra beds almost on a daily basis [because] we’re getting people discharged in a more timely fashion.’ Prof Andrews says that, while many discharges are successful, Ministers are ignoring the ‘significant number’ of those that aren’t. ‘It’s not that more people should be kept in hospital – it is not the safest of places,’ she says. ‘But there are clearly too few services to look after people afterwards, and it’s the job of the Minister to sort this out.’ Experts have also accused doctors of denying elderly patients treatment such as physiotherapy, as they as assume they won’t get better. ‘There is often an assumption that if someone is elderly, rehabilitation is basically pointless,’ says Professor Adam Gordon, consultant geriatrician and president of The British Geriatrics Society. ‘NHS staff need to remember that older people have as much right to proper recovery as any other patient.’ Discharge To Assess drastically lowered the threshold for letting patients leave hospital. Unless they need a drip, intensive care, end-oflife care, aren’t fully conscious or unable to breathe properly, they can be considered for discharge. As part of the policy, the NHS is supposed to pay for six weeks of care and rehabilitation immediately after discharge, such as appointments with a physiotherapist and visits from a carer to help with daily tasks. A £ 600million pot of NHS cash is reserved for this service, sparing local councils from dipping into their dwindling budgets. But Prof Gordon says: ‘Discharge To Assess only works when there’s a rehabilitation element. Currently, many patients are waiting too long for this or it doesn’t happen at all and they deteriorate as a result.’ Prof Andrews adds: ‘Ageism is definitely reflected in the decisions that staff make when they care for older people in hospital. I often have to remind doctors that our aim is to get patients back to how they were – by offering physio and other rehabilitation. ‘But I can tell, often, they lack any ambition to do anything more than the bare minimum for them.’ Government data suggests that Discharge To Assess may have triggered a rise in readmissions. While figures are not yet available for 2022, between 2015 and early 2020 the number of patients being readmitted to hospital within a month rose by 16 per cent – reaching roughly 941,000. And between 2021 and 2022, in 13 out of 191 NHS trusts, readmission rates for over 75-year-olds was above the national average – up from eight in 191 the year before. A MAJOR report published last month concluded early discharge protocols for elderly, frail people do not reduce the risk of hospital readmission or death in hospital. The study’s authors – health policy experts from the London School of Economics – blamed the failings on a lack of access to support services after discharge. Now experts are calling on the Government to take action to prevent more older people ending up back in hospital as the months turn colder. ‘There’s steps both NHS colleagues and the Government can take – and it’s essential they do so now to avoid further catastrophes this winter,’ says Prof Gordon. ‘The NHS needs to start redeploying physiotherapists, specialist nurses and occupational therapists to acute care and A&E, so the staff is in place to help with discharge. ‘The Government should demand NHS Trusts begin recruiting social care staff now in preparation for winter. Ministers could also introduce legislation to ensure that the care that patients can access through Discharge To Assess is consistent across the country. ‘It is up to local authorities and NHS teams to decide whether a person qualifies for this pot of funding or not, and results can vary.’ The wife of a man who’d recently had a leg amputated told The Mail on Sunday that their local health chiefs had ruled that NHS Discharge To Assess would no longer fund her husband’s after-care. ‘We were told the Trust had recently changed its policy,’ she said. Since our last report was published earlier this month, scores more readers have got in touch – with even more shocking stories. See box above. In one case, a frail 88-year-old man was dropped home in the snow by patient transport services, but with no coat and a catheter still attached. The care that was promised failed to show up – and he died shortly afterward. A 95-year-old man was discharged to his house alone despite being blind and unable to walk. When a carer eventually arrived a day and a half later, he was found on the floor, having fallen out of his chair. Meanwhile, the wife of a man dying of blood cancer was forced to move their bed into the living room and become her husband’s full-time carer after nurses failed to offer the support she was promised. ‘These things should not happen,’ says Prof Andrews. ‘But I am afraid that the problems with finding care – and space – for people is only going to get worse. Doctors tell me that problems with bed capacity are already beginning to rise – and we’re only in September.’ A spokesman from the Department of Health and Social Care said: ‘This year, the Government is providing £600million through the Discharge Fund to support timely and safe discharge from hospital. ‘We have also made available up to £7.5billion in additional funding over two years to support adult social care and discharge. ‘It is the responsibility of community health and care services, including GPs and social care providers, to communicate with patients and their carers to ensure that changes are managed appropriately to help with their recovery.’