Poor service integration to blame for dangerous hospital discharges, MPs say

28 Sep 16

Patients are too often being discharged from hospital when it is not safe for them to leave due to poor levels of health and social care integration, according to MPs.

A report released today by the Public Administration and Constitutional Affairs Committee, found that a lack of integration, caused by the historic split between health and care, meant that interdependent services were being managed and funded separately. This “political maladministration” was causing suffering for patients and relatives, it said.

The committee was responding to work carried out by the Parliamentary and Health Service Ombudsman, which it said highlighted “harrowing cases that illustrated the human cost of poor discharge”. These cases were not isolated but were persistent problems across the health service.

Poor patient discharge can take the form of delayed transfers of care, where patients are kept in hospital longer than is necessary, and premature or early discharge, where patients are sent home before it is clinically safe to do so, or without appropriate support in place.

Barriers to the implementation of best practice are prevalent at the interface between health and social care, the committee said. Pressures on resourcing and capacity were “leading to unsafe discharge practices”, and it called on health and social care leaders to ensure that person-centred care remained the undisputed priority.

The report found that while excellent guidance was available, good practice was not being applied equally across the system and more data was needed on the scale and impact of the failures.

Responding to the report, parliamentary and health service ombudsman Julie Mellor, highlighted the human cost that could arise when people fell through the cracks, and blamed the underfunding of social care.

She said: “We see too many cases where discharge from hospital has gone horribly wrong, particularly for older, frail people who often don’t have the right support in place at home to cope on their own.

“These shocking failures will continue to happen unless the government tackles the heart of the problem – the chronic underfunding of social care which is pilling excruciating pressure on the NHS, leaving vulnerable patients without a lifeline.”

Committee chair Bernard Jenkin said some hospital staff felt under pressure to discharge people earlier than was appropriate.

“Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care,” he said. 

He stressed that staff needed to feel a level of trust and openness that enabled them to raise concerns about unsafe discharge.

The report referred to the Better Care Fund and the Discharge Programme Board as being “promising”, in bridging the gap between health and social care. But, it cautioned that these plans were far from implemented.

The committee urged the health secretary to establish a set of objectives for the board, with measures and timelines, so progress could be monitored. Also, it advised the government to set out a route map, by March 2017, to demonstrate how arrangements for sustainable funding for integrated care will be implemented.

Did you enjoy this article?