A Senedd Committee is urging a rethink in how and when hospital patients are being discharged to prevent people being prematurely ‘written off’.
The Local Government and Housing Committee heard that hospital emphasis on freeing beds over patient recovery means that many people who could recover with a proper rehabilitation programme and return home are often sent ‘temporarily’ to residential care homes.
With no recovery programme being arranged at the residence, many patients deteriorate to the stage where they are never able to return home.
The Committee’s new report is calling for the Welsh Government to commit to ensuring that these ‘intermediate care placements’ focus on recovery and regaining as much independence as possible, with therapeutic or nursing expertise where appropriate, to ensure the best care possible for patients being discharged.
The current lack of appropriate intermediate care can lead to the premature deterioration of people’s health and independence, which adds to the costs and pressures facing the NHS and social services, according to the Committee.
Early discharge
Early discharge from hospital, with the option of returning to the ward if the problem reoccurs, has been floated by many as a way of improving the discharge system without sending patients to care homes.
Lauraine Clarke, from Kidwelly, is someone who benefitted when being discharged early from the hospital.
After experiencing a bowel obstruction in March, she was admitted to a ward in Glangwili General Hospital while she recovered.
She said, “When I was first offered the option to be discharged, initially I was quite anxious about the idea. The worst-case scenario would have been to go home, only for things to get worse and then having to go through A&E again – waiting for hours to be assessed - just to get back to where I was. Having had bad experiences with A&E before, I was in no rush to do that again.
“But when they explained that they could discharge me and if I felt any deterioration I could phone and be immediately put back on the ward again, it gave me much more confidence. So, I agreed to be discharged to recover at home, and in the end, I didn’t need to go back to the hospital.
“With this system, it meant one freer bed in the hospital, but potentially one less person going through A&E if my condition had worsened.”
John Griffiths MS, Chair of the Local Government and Housing Committee, said,
"Reducing hospital waiting times and improving discharge rates cannot be achieved by looking solely within hospital walls. The broader health and social care system is beset by critical issues and sending patients prematurely to care homes is just one part of the problem.
“We also heard how chronic understaffing in the care sector is being exacerbated by a lack of digital modernisation and inadequate data sharing between health and social care, all of which negatively affect patients.”
Antiquated technologies
The Committee’s report also highlights worrying examples of NHS Wales’ lack of modernisation which is affecting its efficiency and making lives harder for patients.
The Committee heard that fax machines and paper-based systems are still being used, and between hospitals, GPs, community nursing teams and health boards, patient information is often held on different IT systems which are not accessible to the various staff and teams involved.
The Committee heard evidence of an electronic referral system being used effectively in the Cwm Taf Morgannwg area but that some neighbouring local authorities ‘will not accept these referrals because they have a different process.’
The report says that, to reduce waiting times, electronic health records should be standardised and that the Welsh Government should show stronger leadership and have greater accountability for improving the use of digital systems in the NHS.
Lack of transparency
Many organisations told the Committee that Wales’ NHS and social care sector could do better at publishing the data it collects.
For example, data is collected on the length of hospital discharge delays, and on waiting times for assessments and services and staff vacancies, but none of this is published.
Senior personnel at health boards might know the situation within their own area, but as this information isn’t published widely, people are unable to compare and analyse different areas to get an accurate picture of Wales as a whole.
The Committee is calling this a ‘gap in transparency’ and is urging the Welsh Government to publish data on waiting times for care assessments and services, and staff vacancy levels, to encourage accountability and improve hospital discharge rates.
John Griffiths MS, continued, “We remain frustrated that, in the twenty-first century, the NHS and its partners persist with antiquated technologies - fax machines and paper-based processes - that fragment care and delay action. This failure to adopt standardised, connected electronic care records not only undermines efficiency but also risks patient safety and prolongs unnecessary stays in hospital.
“Equally concerning is the persistent gap in transparency: crucial data on discharge delays, assessment waiting times, and workforce vacancies are collected but not published, impeding accountability and informed decision>“Only by addressing these problems across both the NHS and social care can we move towards a modern service that delivers for the people of Wales."
