Hospital discharges and readmissions

A friend has just sent a helpful and pertinent link to an article titled: “Poor hospital discharges blamed for readmissions”. We had both recently attended a meeting of Southend Homeless Action Network (SHAN) when it was noted that some of our rough sleeper friends were being discharged onto the streets, when our local hospital had come to a view there was nothing more they could do medically for the patient. While naturally we were concerned for the rough sleepers, we could also understand the hospital’s point of view, yet recognised this was yet another gap we try to help to fill.

It got me thinking of when a few years back I did some work with the then Diversity Manager at our local hospital around appointing and empowering homeless champions and the need to check on the current situation (although I am not too hopeful). Things have moved on somewhat since that then and we are now living in different times, which are more austere. Yet the need we identified of being able to send homeless people to somewhere to aid their recovery and rehabilitation remains and, if the reports I am receiving are anything to go by, are still significant.

The report begins: “The way hospitals discharge patients is probably contributing to high levels of readmission, a year-long Healthwatch England inquiry has found. It said many hospitals failed to notify relatives or check patients had any accommodation before discharging them” and ends: “In 2014, the National Audit Office reported the NHS saw a million readmissions within 30 days of discharge, costing an estimated £2.4bn a year. A spokesman for NHS England said hospitals should be making sure patients are appropriately discharged. “We need to ensure appropriate care is put in place before a patient leaves hospital which needs strong joint working across the health service.”” The report is focusing on wider issues than just homelessness and the arguments for addressing the issue are more around economics than compassion, but the findings are pretty damming and highlights the bigger picture and begs the question what we are going to do about it?

I recall when some years back I looked at the boundary between health and social care and later followed the arguments, still relevant and still unresolved, for integrating health and social care, that one of the issues was bed blocking, particularly relevant in the case of the elderly, and that it was not reasonable to expect hospitals to take up bed spaces when there was little it could do on the medical side but equally it was not reasonable to discharge them when nowhere suitable to go and no after care package in place.

Being married to a nurse that regularly deals with some the issues arising out of this dilemma, I am well aware of these realities, but it would be inappropriate to comment further for confidentiality reasons. But as has been noted, both from personal experience and those I am close to and from this report, there is an issue to sort out.

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