'Out of hospital and out of mind'Whipps commentator Mary Burnett fears prompt discharges are putting elderly people at risk
In a recent newsletter, the NHS trust behind Whipps Cross wrote proudly of how they're “accelerating the number of patients being discharged more promptly and safely”, a shift that is vital to their plans to operate post-rebuild with fewer beds and services on-site.
For those who know the older people of this borough, such boasts may set off alarm bells. I've heard many stories of older people whose discharge was certainly prompt but seemed far from safe. I'll tell the story of two - just the tip of the iceberg - whose names have been changed to protect their anonymity.
Elsie, in her late 80s, was living alone and getting out and about until she was admitted to Whipps after a fall. A few days later, she was discharged back home and left sitting downstairs, with no way of getting to the hastily-installed hospital bed upstairs on her own steam. Despite numerous unsuccessful calls to arrange a visit from a care worker, in the end her elderly brother and his wife took the risk of helping her up themselves and returned late at night to their home over 40 miles away. No rails had been installed to keep Elsie steady around the house and, though she was on the waiting list for a home assessment, no-one knew how long this would take. Needless to say, a few weeks later, Elsie fell again using the toilet, fractured her hip and was readmitted to Whipps. She is now too frail to live at home.
Dora, in her early eighties, lived alone, struggling with breathlessness after a diagnosis of lung cancer. After several falls, she too was admitted to Whipps and rapidly discharged while still very frail, very breathless and unable to move without help. To make matters worse, she was discharged back to a home with no hot water. Though Dora was meant to have four care visits each day, on several days she only received two, some lasting a matter of minutes, despite frantic phone calls by her niece.
As a further indignity, both women, and others we've spoken to, were told to use incontinence pads, despite not actually suffering from incontinence. After a lifetime of using the toilet, how can older people be expected to subject themselves to this? It is unsurprising that they would rather risk falling on the way to the bathroom. Whipps' NHS trust is very fond of arguing that old people should get home as soon as possible to avoid their muscles atrophying while they lay in a hospital bed. It seems counterproductive to leave them stuck at home, barely able to get around, without rehabilitation to move safely again and sitting in soiled pads.
Hospitals used to be required to assess people's home circumstances before discharge to make sure they were safe at home and had proper support. Now, because of cuts to beds and staff shortages, we have “discharge to assess” or, in plainer English, sending people home regardless. We know that cuts and government policy are the root cause of all this but the pretence that all is getting better in the community adds insult to injury.
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Offered a chance by the Echo to respond, Dr Heather Noble, medical director at Whipps Cross, said: “We deeply regret the events experienced by Elsie and Dora and are taking the issues raised very seriously. We are working with our local community partners, including Age UK, to improve care following discharge.”