Hospital Discharge: In Reality, It’s Not As Easy As It Was For Ruth’s Mum On The Archers
The Times and the Telegraph both ran stories last weekend about levels of “bedblocking” in England reaching a record high.
In October 2014, 5,000 patients became stuck in hospital needlessly – for days or longer after they should have been discharged. Apparently just in that one month, this equated to more than 143,000 hospital bed days used by patients who should have been able to go home, or have gone to care or nursing homes.
These autumn figures have been released before the standard annual British weather-and-flu-related winter crisis, which will only add pressure to the already over-stretched and under resourced health & social care services.
Common consensus amongst experts is that the problem results from a combination of a lack of NHS staff to discharge patients, and a lack of social care services to support people when they return home.
We have had an increasing number of queries from clients who are anxious for their relatives to be discharged from hospital, but equally anxious to ensure that it is a safe discharge with adequate community support in place. Understandably, families want to prevent the risk of more harm; and to avoid the revolving door of repeated hospital admissions through A&E that can result from inadequate support at home.
Alarmingly, some families are being threatened with financial penalties or even court action if they don’t get their relative out of hospital and back home or in to a care home. Some hospitals suggest that families are “choosing” to allow relatives to bed-block. In our experience, while threats of this type are rarely acted upon, pressure is often unfairly applied against families, with no recognition that the failure to plan and arrange a safe discharge is a fault of the system, not a fault of the family.
Just last week I had to remind an experienced Social Worker who complained that a family had had “long enough” to find a care home, that this was the Social Worker’s legal responsibility – or at least a joint working responsibility between the Social Worker and the family – and not the family’s job.
These stressful situations are difficult for every family who encounters them, the family has to balance their worry surrounding:
- A vulnerable relative who is facing a health crisis
- Getting to grips with a health and social care system that is riddled with holes
- The family often find that the first answer given to them is “No”
- Where anticipated assessments are not undertaken
- Where jargon is common-place
- Where passing the buck has become the norm
This is hard enough if the family live within a reasonable distance of their vulnerable relative, but can feel impossible if you are an adult child living hundreds of miles away from your elderly parent; or living abroad with no one close by to take on the extra responsibility.
The Archers on BBC Radio 4
Contrast this, if you will, with the long-running story of Heather, Ruth’s mum in the BBC Radio 4 soap The Archers. Ruth Archer and her family live in the wonderful made up area of Borchester. Heather meanwhile lives in the real county of Northumberland. Heather has been in and out of hospital after falls and fractures. Ruth – 300 fictional mile away – is understandably plagued with worry about how to get her mum back home and safely cared for.
Her mum doesn’t want to go to a care home and won’t move south to live at the family farm. Leaving aside the story-line that Ruth & David are prepared to sell Brookfield Farm and move 300 miles up North with their cattle, children and David’s mother to ensure that Heather can stay in her own home.
Heather has had an excellent story-book hospital discharge. She has had Occupational Therapy assessments and Physiotherapy treatment to ensure her optimum recovery. Health and/or Social Services even offered her overnight carers in her own home. Whereas in reality, overnight care is a support service that most Councils withdrew years ago. Heather declined this rare offer of overnight support – whereas most of our clients would gratefully seize this lifeline with both hands.
I am not criticising the The Archers story line – I think it is fantastic that a broad-appeal soap is tackling the issues that adult middle-aged children face when their elderly parents need care and support – particularly when geographical distance is a factor. I would just highlight the fact that the storyline exposes the stark difference between what Health and Social Services say that they will or can do, and what they actually do in the real world. There is law and guidance about safe hospital discharge.
In too many real-life cases these legal duties are ignored and families are forced in to making patchwork emergency arrangements that are in no-one’s best interests and that are often unsustainable. In the long term, the arrangements collapse, which inevitably places more pressure upon Health & Social Services.
Rights for Those in Care
People who are stuck in hospital with care and support needs, who should be back at home with a care package that helps them keep or recover their independence (ultimately reducing their reliance on the NHS in a crisis) have a right to assessments, care and support planning.
This right exists regardless of how that care package is to be funded. It is a right that often seems to be overlooked or forgotten about. The Government needs to resource this assessment and planning stage properly, to reduce bed-blocking, and enhance opportunities to return to more independent living. This needs to be done before the Care Act 2014 regulations take effect next year – otherwise all those years’ work to reform the community care law that underpins the Health & Social care system will sadly, be wasted.
If you or a loved one has been effected by any of the points raised in this article, please contact us or call on 01273 609911.