Hospitals: Unsafe Discharge

Baroness Masham of Ilton Excerpts

Wednesday 9th November 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Baroness, Lady Wheeler, for bringing this most worrying matter before your Lordships today. The Parliamentary and Health Service Ombudsman’s report and its follow-up should be acted on by everyone responsible for the NHS and, by Members of Parliament who are responsible for helping their constituents, as well as by voluntary organisations and the public. Unsafe discharge from hospital can happen throughout the country. Pressure on most hospitals throughout the country has reached a tipping point. Better communication throughout the NHS is absolutely vital.

I want to bring to your Lordships’ attention the case of Mrs F, one of the cases illustrated in the report:

“A woman in her 80s was discharged from hospital to an empty house, in a confused state with a catheter still inserted”.

She had been,

“admitted to hospital with a urinary infection. She was seen by a consultant who decided she should stay in hospital for three days so that the infection could be treated and staff could monitor her. Despite this, and for reasons that are unclear, Mrs F was discharged later the same day to an empty home and in a confused state. She had been given no medication and still had a catheter inserted”.

A neighbour,

“contacted the ward sister at the hospital who said that Mrs F should not have been discharged”.

The report concluded that:

“It was wrong to discharge Mrs F against the consultant’s instructions. There was nothing in Mrs F’s medical notes to explain why the consultant’s instructions had been changed or who had changed them. This went against recognised standards about record keeping. The hospital accepted that Mrs F’s discharge was inappropriate, and that there was no documentation about the discharge or who arranged or authorised it. However, it failed to get to the bottom of what had happened”.

Is this not a clear example of a cover-up? I wonder how many such cases across the country never come to the notice of the ombudsman.

I must mention the unsafe discharge from hospital of people apart from the elderly. A baby died after being sent home from hospital with paracetamol when he had meningitis. His mother said:

“To lose your child to an illness that is both preventable and treatable is a tragedy. By sharing our story we hope to save lives in the future as people become more aware of the symptoms and of the impact this horrible disease can have”.

Another baby was sent home from a hospital department which had a warning poster about meningitis but the mother was told the baby had gastroenteritis. A schoolgirl of 16 was sent home from A&E after being told she had a migraine. She later returned to hospital with a rash but died. Waiting for a rash can be fatal. I wonder how many people have died in the past year from meningitis and sepsis due to misdiagnosis.

I have a friend whose son became mentally ill at the age of 18. He went berserk one afternoon, brandishing an air gun. As the situation was out of control, the police were called. They took him to Northallerton, where it was realised that he was seriously mentally ill. He was admitted to the local hospital’s one ward for mentally ill patients and was later transferred to a more secure ward at Middlesbrough, where he remained for six months. The consultant then told his parents that he could be discharged home. They said that they would not be able to cope, and they feared for his safety and that of the community. He was then sent to the first hospital, where the consultant told the parents that it would have been a disaster if he had been sent straight home. How many unsafe discharges of mentally ill patients will there be when the pressure on beds becomes insurmountable, with no slack in the system?

With the elderly population increasing and with complex conditions, the local population in North Yorkshire are dismayed at the closure of the Lambert Memorial Hospital in Thirsk. This hospital has taken the pressure off the local district hospital when people need 24-hour care but not acute surgery. Too much pressure on hospitals means too many unsafe discharges.

I am pleased to see that Healthwatch England has been involved in the safe discharge of patients. In 2014-15 it conducted its “safely home” inquiry, highlighting the impact on patients and their families when discharge goes wrong and identifying good practice where things go right. It also welcomed the publication of the Parliamentary and Health Service Ombudsman’s report and its role in highlighting the continued importance of ensuring that discharge is undertaken safely, effectively and respectfully.

The purpose of Healthwatch England and the 152 local Healthwatch organisations is to understand the needs, experiences and concerns of those who use health and social care services, and they were granted the statutory powers to speak out on their behalf. Healthwatch needs to stand up and be counted by helping uncover cover-ups, supporting patients and promoting good practice in both NHS and social care. The combination of services is important.

The Royal College of Nursing stresses the vital contribution of the community nursing workforce in relieving pressure on the system and delivering care in the community. The RCN is clear that any poor care is unacceptable and that action must be taken where breaches of the Nursing and Midwifery Council code occur. It is important—so that solutions can be found—that these cases are viewed within the wider context of the pressures facing the health and care systems.

I am pleased that the BMA supports the conclusions of the ombudsman’s report and welcomes the committee’s follow-up inquiry. It states that it is of paramount importance for patients, as well as their families and carers, that they are discharged from hospital in a safe, appropriate and timely manner that is co-ordinated and centred on their needs. There are extra needs for people with dementia and their carers. I hope that the Government, too, will do their very best to make the discharge of patients safer and better. This is not only a local matter; it is a matter of national concern.