Hospital Discharge

Staff reported problems in accessing NHS
Continuing Healthcare funding for patients who
were at ‘end of life’. There are National Framework
guidelines (NHS 2012) for patients with a rapidly
deteriorating condition potentially entering a
terminal phase, so that their assessments for
continued healthcare can be carried out quickly.
This is designed to ensure that appropriate
care is provided for patients in their preferred
location for dying. However, ward staff identified
that this protocol was not always followed. Our
interviewees reported that due to changes in
assessment criteria patients were unable to
access NHS Continuing Healthcare funding and
that these delays were distressing for patients,
their families and staff:
The fast-track all changed … And I think, since that
happened, I know of three patients that died here
when their wish was to die at home. … It’s quite
heart breaking and soul-destroying, to know that
you’re not- that’s all they want. They want to die at
home, their family want them to die at home, and
you can’t do that for them, because of, you know,
the time constraints and stuff. …A lot of the time
they’ll say they need a checklist, and I’ll say, “But
hang on a minute, they’re not going to be around
for your checklist. They need to get out.” …By the
time they do the checklist, they’re either not going
to make it out of hospital, or they don’t get here in
time, and they’ve already died. (Francis)
As we shall see when we present the discharge
team staff data issues relating to fast-track for
‘end of life’ patients were seen as a considerable
problem during the period in which we
conducted our study.
7.1.3 Family involvement
in discharge planning
Research on hospital discharge tells us that
involving families in discharge planning
consistently leads to better outcomes for patients,
and that the presence or absence of a family carer
can have implications for delayed discharge,
as family and friends often provide support in
maintaining older people in the community
(Victor, Healy, and Thomas, et al., 2000). While
NHS guidance recommends that family carers
are kept informed and given the opportunity to
contribute, many of the ward staff we spoke to felt
that families could be ‘difficult’, delaying patient
discharge by raising unnecessary concerns
about their relative’s living situation. As one
member of staff described:
Generally, most patients want to get home as soon
as possible. Families can be difficult because they’ll
have their own opinion, their house is a mess or
they’ve got beer cans all over the house but they
forget that if the patient’s got capacity and that’s
the way they want to live, and that can be difficult
because they’ll say, “How can you send them
back?” That’s the way they want to live and as long
as they’re safe and the place is safe. (Alex)
Another member of staff on the same ward also
felt that some families did not want to facilitate
hospital discharge; she reflected:
I think some relatives, kind of feel that their
relatives are in hospital for a certain amount of
time, that’s therefore a given, and they can be quite
obstructive in helping out. It’s not an urgency to
get people discharged, I think that’s a bit unfair. But
they don’t, I don’t think they appreciate the need
for the bed. (Francis)
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