Hospitals in England have been instructed to stop the practice of discharging patients in the middle of the night in order to free up beds.
The NHS medical director Prof Sir Bruce Keogh, has written to Strategic Health Authorities saying it is unacceptable to send people home when they may have no family support. Figures show that 100 NHS trusts sent 239,233 patients home between 23:00 and 06:00 in 2011. The Times reported that some 3.5% of all hospital discharges took place between those hours and this rate had steadily held for the past five years. The Times had contacted 170 NHS trusts in England but only 100 responded. The rates of those discharged varied widely between different hospitals.
“While some patients may of course choose to be discharged during these hours, the examples highlighted of elderly patients being left to make their way home by themselves in the middle of the night are obviously unacceptable, and need to be addressed urgently,” Sir Bruce wrote. “As health professionals we all agree that patients should be treated with compassion, so it is simply not acceptable to send people home from hospital late at night when they may have no family members nearby to support them.”
“I would like your assurance that appropriate arrangements are in place in all NHS Trusts to ensure timely discharge and care transfer for all patients, and I expect to discuss the outcome of the actions I have requested when we next meet on 8 May,” Sir Bruce said. Sir Bruce will meet medical directors of Strategic Health Authorities in May to check on their progress.
“We have got to get to the bottom of this issue,” said David Stout, deputy chief executive of the NHS Confederation, which represents managers. “In order to do that we will need information to be collected consistently across organisations. However, what is critical is making sure hospitals are confident that their arrangements for discharging patients and getting them home are both appropriate and safe.”
Katherine Murphy, chief executive of the Patients Association, added to the newspaper: “While we applaud his sending this letter, we would question why NHS managers are doing it in the first place. It’s a sad indictment that we’re having to remind senior professionals that it’s unacceptable behavior. They shouldn’t need reminding about caring.”
Prime Minister David Cameron is due to meet nurses in Downing Street later for the first Nursing and Care Quality Forum to discuss concerns about patients' treatment. The forum is made up of frontline nurses, patient representatives and medical experts. Mr Cameron said he had asked forum members to “scour the country, find out what works best and share it across the NHS”.
Meanwhile waiting times are increasing by the day. New research by the Patients Association also shows that fewer patients are undergoing planned operations such as joint replacements, cataract removal and hernia repairs, as the NHS tries to make £20bn of efficiency savings at a time when demand for healthcare is growing. A report from the association, based on information supplied by 93 of England's 170 acute hospital trusts, found that waiting times for a range of elective operations rose between 2010 and 2011.
The average wait before having a new knee fitted rose from 88.9 days to 99.2 days, while patients needing hernia surgery typically waited 78.3 days in 2011 compared with 70.4 the year before. The delay before the removal of gallstones increased over the same period, by 7.4 days, as did the delay before having a new hip (6.3 days longer), hysterectomy (three days) and cataract removed (2.2 days).
Trusts that supplied figures jointly performed a total of 18,268 fewer operations for these conditions in 2011 than in 2010, with those blighted by worsening vision, especially older people, most affected.
“It does look as if this report has confirmed something we have been worried about for the last two years, that patients are waiting longer in certain trusts to receive the treatment that they require and that fewer patients are getting the operations they need,” said Prof Norman Williams, president of the Royal College of Surgeons of England. “We are very concerned about this and really worried because patients who do not get the treatment they need within an appropriate time could be storing up problems for the future.”
Waiting times for the eight types of elective surgery studied rose by 6% year on year, and the number of such procedures carried out over the same period fell by 4.6% – the second successive year those trends have been seen – said Katherine Murphy, the association's chief executive. “Patients are calling our helpline to tell us they are being left to wait in agony and that their desperate calls to the hospital for help are being ignored. We hear lots of talk from the government about waiting times falling but whilst this may be true in other areas, it doesn't address the problem in relation to elective surgical procedures,” she said.
But the health department said data from every hospital trust showed waiting times were low and stable and more patients were being treated, including for conditions in the report. The document was based on “partial: data and did not reflect the situation across England, it added.
Health secretary Andrew Lansley said, “There are fewer patients than ever waiting a long time for treatment in the NHS. The number of people waiting over a year for treatment has reduced by two-thirds since we came into office and the average time patients have to wait for treatment is at the same level as two years ago.”
“We publish waiting times for different areas of medicine and surgery once a month, every month. They show that the average time that patients wait in areas that cover the operations selected by the Patients Association such as orthopedics, eye medicine and general surgery, have either fallen in the last year or remain stable at very low historical levels,” he added.
Andy Burnham, the shadow health secretary, said Cameron had “not been straight with the public about waiting times in the NHS”. He added, “After inheriting the lowest ever waiting times in 2010, it would now appear that the NHS has gone backwards for the second year in a row and that is clearly linked to his disastrous decision to reorganize the NHS at this time of financial challenge. The prime minister has made waiting times the central test of his stewardship of the NHS and, based on the emerging evidence, it is clear he is failing patients as they are left to wait in pain and discomfort.”
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