“It’s time to respond to the ‘chaos’ at the back door.”
Don Redding, Director of Policy and Partnerships for National Voices, responds to the Adult Inpatient Survey 2017 results, exploring experiences around discharge from hospital.
In a room somewhere near the back door of the hospital sits a typical hospital patient: a woman, mid-eighties, with several conditions, loneliness and mild confusion.
She no longer has a bed, and is thus of no further interest to doctors, nurses, bed team meetings, or ‘flow’ managers.
But she is not at home. She is waiting. And when she gets home, many uncertainties await.
For two decades people in her position have been of no interest to politicians, nor therefore to NHS leaders.
Obsessed with the idea that patients=voters=consumers, politics has relentlessly focused on access to NHS services – getting in the front door.
You have rights to be referred, treated, seen in A&E within given times or flags are raised, breaches punished, fines imposed. You have no rights at the back door.
Reporting on the Adult Inpatient Survey 2017 the Care Quality Commission has, rightly, sought to tackle this bias, highlighting that discharge is the weakest area of patients’ experience of hospitals.
Only 54% of respondents said they were definitely involved in decisions about their discharge. This has not improved since 2009.
Two fifths (41%) said they had to wait around, usually because they hadn’t been given their medicines to take home. A quarter of them waited over four hours (unlike A&E, no flags).
Nine out of ten patients were discharged to home, but only just over half (53%) said they definitely got the professional support they needed to recover, and manage their condition; with 22% saying support would be useful but they didn’t get it.
We may live in an information age, but not at the back door. Weaknesses here include not giving people written information on how to manage after discharge (38%); not telling patients about side effects of new medicines (43%); not giving information to family, friends or carers (25%); not discussing needs for other services, even when the patient wanted this (19%).
Most of these results are worse for anyone with a mental health condition or dementia.
Elsewhere, this survey carries good news. Reported experience of being involved in decisions remains stable, and communication with doctors and nurses continues a long trend of gradual improvement.
National Voices’ report on trends in experience, Person Centred Care in 2017, had sounded the alert that such improvements may be at risk due to pressures such as overwhelming demand and understaffing.
To find that the 2017 results show that busy NHS staff are succeeding in good communication with their patients despite those risks is tremendously welcome. (Although with the caveat that these results predate the difficult winter of 2017-18.)
But, if people like our typical patient were waiting on chairs and trolleys in the corridors of A&E, and then receiving sub-optimal and uncoordinated services, ‘chaos’ headlines, political announcements and swift national directions would follow.
It’s time to respond to the ‘chaos’ at the back door.
National Voices is the coalition of charities that stands for people being in control of their health and care. Learn more about how National Voices help people and organisations to improve the knowledge, understanding, skills and confidence they need to engage more effectively and to make their approaches more person-centred. Visit the National Voices website or follow them on twitter @NVTweeting. You can also follow Don Redding on twitter @MightyDredd
 The Adult Inpatient Survey looked at the experiences of 72,778 people who were discharged from an NHS acute hospital in July 2017