Opinion

We need to talk about hospital discharge failures

Nurses must speak up for older people who have bad experiences of hospital discharge, says the RCN's professional lead for care of older people
Dawne Garrett

Nurses have a duty to report incidents of poor care and speak up for older people who have bad experiences of being discharged from hospital, says Dawne Garrett.

The recent Public Accounts Committee (PAC) report on discharging older people from acute hospitals in England revealed that rising numbers of patients are remaining in hospital when they are clinically ready to go home.

PACs report acknowledged that these delays may increase the amount of care people need once they leave hospital. We know from National Audit Office figures that discharge delays lead to a gross cost to the NHS of about 800 million a year.

Nursing input

Nurses play a pivotal role in seamless care transfer and have ensured effective support for older people through flexible practice. We have a duty to share ideas and support developments to improve poor discharge. Intermediate care is effective

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Nurses have a duty to report incidents of poor care and speak up for older people who have bad experiences of being discharged from hospital, says Dawne Garrett.

 

The recent Public Accounts Committee (PAC) report on discharging older people from acute hospitals in England revealed that rising numbers of patients are remaining in hospital when they are clinically ready to go home.

PAC’s report acknowledged that these delays may increase the amount of care people need once they leave hospital. We know from National Audit Office figures that discharge delays lead to a gross cost to the NHS of about £800 million a year.

Nursing input

Nurses play a pivotal role in seamless care transfer and have ensured effective support for older people through flexible practice. We have a duty to share ideas and support developments to improve poor discharge. Intermediate care is effective after a hospital stay when further assistance is required to restore a person's functioning to pre-admission levels.

The National Audit of Intermediate Care 2015 highlighted that most people using support services had a positive functional outcome – 92% who received intermediate care or re-ablement services at home maintained or improved their dependency score. With community hospital or care home-based intermediate care, 93% of people maintained activities, confidence and a state of well-being.

Leadership

Intermediate care teams rely on nursing and nursing leadership and the RCN has done much to champion these services. However, as PAC reports, failures at national level to address long-standing barriers to taking up good practice are resulting in unacceptable local variations. Investigating the work of the vanguard sites can engender multidisciplinary collaboration and encourage us to continue drawing attention to the pressing need for increased funding and practice development.

Nurses frequently care for people who have not had an excellent discharge from acute care. We should bear in mind the professional obligations placed on us by the Nursing and Midwifery Council to speak up in these cases and report incidents that do not represent good practice consistently and tenaciously. It is equally important that we inform, educate and motivate our colleagues and the public about the models that work so that older people receive the nursing care they need.

Dawne Garrett
Photograph: David Gee

Dawne Garrett is RCN professional lead for care of older people

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