An inquiry by Healthwatch England, the official NHS watchdog, has concluded that the NHS is squandering resources by systemic failings in procedures for discharging patients from hospitals.
The results of the Safely Home study are of profound concern, both for patient safety and NHS resources. Healthwatch England estimates that one million patients discharged from hospital needed to be re-admitted within 30 days. Almost one in five were back in a week. The inference is that many patients are being discharged prematurely because of inappropriate decision-making and a lack of effective social care and support after discharge.
The cost to the NHS of discharging patients early is estimated at £2.4 billion a year.
The reasons for early discharge are complex and many factors come into play. Balancing the competing demands and priorities of different patients against finite hospital resources are clearly a significant contributor but this study highlights a large number of cases in which these were compounded by a lack of compassion or common sense.
Healthwatch England identified basic principles that would have made a material difference in many of the cases in its study. These simple steps include asking patients where they will go after their discharge; getting in touch with families and carers beforehand; and making sure that details of hospital medications are handed to carers and made known to GPs.
The study interviewed more than 3,000 patients about their experiences of admissions and discharge from hospitals across the country. It concentrated particularly on those perceived to be more vulnerable – such as the elderly, homeless and those with mental health conditions.
Commenting on the report, Andrew Clayton of Penningtons Manches' clinical negligence team explains: "This is not simply a report on the waste of NHS resources but raises very serious concerns for patient safety. Some of the individual stories reported to Healthwatch England are tragic. They include a man with mental illness who attempted suicide and was discharged from hospital with no psychiatric support. He killed himself a week later. In another case, arguments over which public body was responsible for funding a patient's care after discharge led to him remaining in hospital for months longer than was necessary.
"Much political attention has recently been focussed on the need for better integrated healthcare with more effective social provision but this study gives little reassurance that there is any change - or that it is happening quickly enough. The NHS can ill afford the costs consequences, particularly at a time when further public spending cuts are anticipated.
"We know from those seeking our advice that early discharge from hospital often leads to serious deterioration and more profound health problems that would have been avoided without premature discharge from hospital. Patient safety cannot be put at risk by the systemic failings highlighted in this report."