Patients sent home ‘alone and afraid’ as Ombudsman slams hospital discharges

Many patients are being inappropriately sent home from hospital “alone, afraid and unable to cope”, according to a damning new report.

People are being “badly let down by the system”, the Parliamentary and Health Service Ombudsman (PHSO) said after its new report highlighted the “harrowing” impact of poorly managed hospital discharges on patients and their families.

The authors say that being discharged from hospital to the comfort of one’s own home should come as a relief, but in many cases this “couldn’t be further from the truth”.

After noting a sharp rise in the number of investigations related to discharges from hospital, the PHSO detailed nine cases in a report to illustrate the magnitude of the problems. These include:

• One tragic case of a woman in her late 90s who was discharged without being examined properly. Moments after she was dropped home she died in her granddaughter’s arms.
• Another describes how a hospital sent an 85-year-old woman with dementia home alone at 11pm, without informing her family.
• And an investigation found that a father’s death from sepsis could have been avoided if he had been treated for the condition before he was discharged from hospital.
• An elderly man with vascular dementia and a personality disorder was discharged but ended up being “locked” on a psychiatric ward for one year.

The Ombudsman concluded that many patients are being sent home before they are clinically ready to leave hospital and others may be medically fit to be discharged but may not be practically ready to cope at home.

Meanwhile, relatives and carers are not always being alerted when patients are discharged and some patients are being sent home with no care plan in place.

“Our investigations have found that some of the most vulnerable patients, including frail and older people, are enduring harrowing ordeals when they leave hospital,” said Parliamentary and Health Service Ombudsman Julie Mellor.

“Poor planning, co-ordination and communication between hospital staff and between health and social care services are failing patients, compromising their safety and dignity.

“Health and social care leaders must work harder to uncover why ten years of guidance to prevent unsafe discharge is not being followed, causing misery and distress for patients, families and carers.”

Commenting on the report, Caroline Abrahams, charity director at Age UK, said: “Most people would assume that in a civilised society no older person would ever be pressured to leave hospital without adequate support being in place, yet recent calls to Age UK’s advice line also show that in our hospitals today, good basic discharge practice is by no means guaranteed.

“As such this report and the dreadful cases it describes mark a new low in what looks like a continuous downward trend in the capacity of our health and care system to look after our older people adequately – indeed, on occasion even in its ability to keep the most vulnerable safe and alive.”

Jeremy Hughes, chief executive at the Alzheimer’s Society, added: “All hospitals should have a discharge policy that takes the needs of people with dementia into account.

“People should be assigned a discharge co-ordinator who ensures they have a health and social care assessment, and that an appropriate support package is put in place to meet the needs of the person with dementia and their carer. The date and time of discharge should be discussed and arranged with the person and their carer with at least 24-hours’ notice, along with transport to their home or care home.

“Substandard care and poor hospital discharge can fundamentally change the lives of people with dementia and their families for the worse.”

Jane Mordue, interim chairwoman of Healthwatch England, added: “From the moment we are admitted, all staff across health and care services need to start planning how and when we are going to leave hospital.”

Heidi Alexander, Labour’s shadow health secretary, said: “This report raises serious questions about why older people are still suffering these awful and completely avoidable failures of care.

“Even with all the guidance that is in place too many older people are experiencing a standard of care that falls well below established good practice.

“It should be a matter of course for relatives and carers to be told that a loved one is leaving hospital.

“It is also simply not acceptable for any patient to be discharged before they are medically fit and without a proper assessment of their needs.

“Sadly, the cuts to social care we have seen over the last six years have contributed to some of these failures. The report highlights lengthy delays in providing care in the home for older people, which means they can end up being stuck in hospital wards unnecessarily for weeks or months on end.”

A spokesman for NHS Improvement said: “Patients should never be discharged from hospital without the appropriate safeguards in place and without families having been informed.

“Better discharge processes, such as those being worked on by NHS Improvement’s Emergency Care Improvement Programme to support local health systems to make improvements, will result in vulnerable patients being protected whilst reducing potentially harmful delays in appropriately discharging those who are medically fit.

“Rather than frail elderly people staying in hospital longer than they need to, it is better to get patients home as quickly as possible and to assess them in their own homes rather than in a hospital – but this must be done with the right help and support in place.”

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