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NHS: Unsafe Hospital Discharges - Question

– in the House of Lords at 11:22 am on 15th June 2016.

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Photo of Baroness Walmsley Baroness Walmsley Liberal Democrat Lords Spokesperson (Health) 11:22 am, 15th June 2016

To ask Her Majesty’s Government what action they are taking, in the light of the report of the Parliamentary and Health Service Ombudsman, to prevent unsafe discharges of frail and elderly people from hospital.

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

My Lords, unsafe discharge of frail elderly patients is unacceptable. Discharge can be very complex, and the integration of health and social care is vital for safe, joined-up care. We are using sustainability and transformation plans to promote integration, supported by the better care fund, creating a seven-day NHS and supporting local systems to develop integrated discharge systems and new models of care.

Photo of Baroness Walmsley Baroness Walmsley Liberal Democrat Lords Spokesperson (Health)

I thank the Minister for his reply, but is he aware that the ombudsman reports patients being discharged before they are clinically ready, without being assessed or consulted and without a care plan or their family being told that they are coming? Does he know why this is still happening 12 months after Healthwatch England’s report on the same issue? Does he agree that this not only puts an enormous financial burden on the NHS but is an appalling way to treat vulnerable people?

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

My Lords, there are millions of interactions between patients and consultants and doctors every day of the year, and there will be some mistakes. We cannot draw conclusions from one or two desperate situations. In so far as they reveal systemic problems, it is valid to draw attention to individual cases of this kind, and there are some systemic issues lying behind the PHSO’s report. In particular, it states:

“We are aware that structural and systemic barriers to effective discharge planning are long standing and cannot be fixed overnight … health and social care … have historically operated in silos”.

That is the issue on which we should be focusing.

Photo of Baroness Pitkeathley Baroness Pitkeathley Deputy Chairman of Committees, Deputy Speaker (Lords), Chair, Select Committee on Charities

My Lords, I ask often in this House and elsewhere about co-operation between health and social care. Does the Minister agree that one thing we lack is a cohort of people, be they nurses or paid professional carers, who can work across health and social care in hospital and follow patients into the community? Will the Minister update the House on what is happening to encourage that kind of cohort?

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

The noble Baroness is right. Most well-run hospitals will have integrated discharge teams comprising people who work in the community, social care workers and people who work in the hospital. However, the fact is that over the last 20 years, with the benefit of hindsight, too much resource has gone into acute hospitals and not enough into primary care and community care. You cannot wish into being lots of district nurses overnight. There are some parts of the country—I will pick on Northumbria and Salford, for example—where serious integration is now going on, with hospitals also managing adult social care, GPs and community care.

Photo of Baroness Butler-Sloss Baroness Butler-Sloss Crossbench

May I pick the Minister up on one point? He said that there were one or two examples, but my understanding is that this is right across the country.

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

The noble and learned Baroness is right, up to a point. I said one or two because the PSHO report focuses on nine individual cases. In so far as they are representative of behaviour across the country, they are important, but I want to put on record that the vast majority of hospitals the vast majority of the time are getting their discharge procedures are right and are doing an outstanding job.

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Shadow Spokesperson (Health), Shadow Deputy Leader of the House of Lords

My Lords, the Minister has readily identified the problem of unsafe discharges. Why is there no explicit reference to this issue in the NHS mandate to NHS England for 2016-17?

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

I cannot give the noble Lord a reason off the cuff. It is very much a part of the better care fund. There is a CQUIN for 2016-17 that is focused on delayed discharges. One of the fundamental purposes underlying the STPs and the vanguards, which are a critical part of taking the Five Year Forward View into a serious plan, is to reduce delayed discharges and improve the relationship between acute care and social care.

Photo of Lord Rennard Lord Rennard Liberal Democrat

My Lords, given that those nine cases were considered to be representative of the problem, does the Minister agree that it might be cost-effective to make greater use of voluntary sector organisations such as Age UK in better preparing people who are frail, elderly and on their own for going into hospital, and then looking after them when they are leaving, to avoid unnecessary, expensive and painful readmissions to hospital?

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

The third and voluntary sectors have a potentially huge role to play. I was talking this week to the chairman of the Chelsea and Westminster Hospital about the plans he had for involving the voluntary sector far more in discharge planning, particularly for frail and elderly people. I agree entirely with the noble Lord’s sentiments.

Photo of Baroness Wall of New Barnet Baroness Wall of New Barnet Labour

My Lords, the Minister has referred to the STP, the sustainable transformation plan. Could he accelerate the way in which that plan is now going? We are into phase one, and some of the shocking things in the report that the noble Baroness, Lady Walmsley, has referred to could be remedied by using the STP properly. I wonder if we should look further and quicker at how we can achieve that.

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

My Lords, this is a difficult issue. You can lead a horse to water but you cannot make it drink. To some extent you have to rely on local people working together, and it is behaviour and culture that determine long-term sustainable improvement. If we try to force the pace beyond that at which local people are prepared to go, in the long run we may not make as much progress. In the first instance we hope that the STP process, involving all local people and giving them a framework for working together, will deliver the results we need. If it does not, we will have to revisit it.

Photo of Baroness Watkins of Tavistock Baroness Watkins of Tavistock Crossbench

My Lords, could the Minister ask why the NHS has not considered funding nursing home places for people who are ready to be discharged for two or three weeks, so that they can have 24-hour care funded by the NHS while they prepare to move back home? People who live alone, in particular, are just waiting for financial assessments while reducing other people’s access to acute hospital beds, including young people who are routinely having standard operations cancelled.

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

My Lords, looking back over 20 years, the reduction in the number of what you might call step-down facilities—community hospitals and the like—has been a huge mistake. We lack step-down facilities. In America they are called skilled nursing units. The fact is that an acute hospital is not a good place to be for anyone once they are medically fit to be discharged; all the evidence suggests that it is more expensive but, more importantly, less good for the patient. I agree entirely with the noble Baroness that we need to explore avenues of discharging people earlier to nursing homes, community hospitals or, better still, back home with the right community support.