Poor flow of patient information puts vulnerable people at risk – report

http://www.theguardian.com/society/2015/jan/15/poor-flow-patient-information-vulnerable-people

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The safety of vulnerable people is being put at risk because they are discharged from hospital without proper information about their condition and future needs, the state-funded “consumer champion” Healthwatch England has found.

Scan and test results, consultants’ notes and other information vital to the continuity of care are lost or misplaced, it says, following a special inquiry into people’s experiences after they have returned home or been sent to other care settings.

Some early findings, described by Healthwatch’s chief executive as “extremely troubling”, have been revealed as evidence mounts of a “bedblocking” logjam overwhelming some hospitals, adding to the crisis in A&E services and forcing the cancellation of routine operations.

The full report and recommendations is expected in March.

Disturbing evidence of harm caused by a poor flow of information within and between the NHS, local authorities and other care organisations includes the case of a homeless man discharged into temporary accommodation with the late stages of mouth cancer. He was receiving chemotherapy and was sent to a flat with no heating, unable to feed himself and provided with three large bags of medication, which he did not know how and when to administer.

He contacted an outreach nurse but she then had to wait three hours in the local housing department to find the address. She found the man shivering in a thin fleece, soaking wet and unable to swallow, and without any support from the local authority that had put him there.

In another case, care support workers did not realise someone had been put on a palliative care pathway, and in a third, staff accidentally administered a patient’s existing medication as well as the new medication intended to replace it.

The inquiry also found cases where people who had previously engaged in self-harming and suicidal behaviour, and had usually been admitted to hospital for this reason, were offered only a crisis support phone number on leaving. This had led to a substantial “escalation” in their crisis and “in a couple of cases” resulted in death.

The first hint of the problems emerged last week in an unheralded report by the government’s Independent Information Governance Oversight Panel to health secretary Jeremy Hunt, in which Healthwatch shared some of its findings on discharge failings. Its inquiry centred on the experiences of older people and those who had been homeless or had mental health problems in the belief that if the system can be made right for them, it would be improved for everyone.

Katherine Rake, Healthwatch’s chief executive, said the findings showed the “very human consequences of not having these basic processes right”. Citing the example of the patient on palliative care, she added: “If that happened to your mum, your parents, you would live forever with the notion that they did not have the best care they could have done. You can’t undo that. We all scratch our heads wondering why these very basic things don’t happen.”

Discharges from one part of the health and social care system into another had been an issue for some time, said Rake, adding: “There does not seem to have been an improvement, indeed the opposite. I think emergency readmissions have gone up by something like 27% over the last decade.

“Obviously not all of that is due to unsafe discharge. But the many examples we have heard could have been prevented through better planning.”

Rake said there had to be a better, systematic way of understanding people’s health and social care needs. “None of this appears to be rocket science but quite why it is happening and what can be done about it is the next stage we should move to.”

Anne Beales, a former user of mental health services who now works in one, and who acted as a consultant on the inquiry, said Healthwatch had “really listened to the people who know best, the people in receipt. They hold the solutions”.

Paul Wilson, once homeless himself, conducted interviews with homeless people for the inquiry. “There was never a complaint about doctors or nurses. It was always about the system. They were very angry about that.”

The Department of Health said: “We know the NHS is busier than ever before, which is why we’ve given the NHS a record £700m this winter for more doctors, nurses and beds. There are fewer long waits to be discharged as a proportion of hospital admissions over the last few years, and we want to see the NHS work with councils to ensure people are discharged from hospital safely and quickly.”