A Bristol hospital patient was turned away from a care home after being delivered by ambulance “unconscious in a wheelchair” in front of a distressed relative, a health board heard. The upsetting incident was highlighted by watchdog Healthwatch Bristol as it compiles a report into the experience of patients with complex needs, who are well enough to leave hospital but not ready to return home and require further care.
An anonymous survey of service users, families and staff in the health and care sector has unearthed failures and concerns in how the system called 'discharge to assess' is working in the city for people who need a high level of ongoing care. Healthwatch area lead Julie Bird told Bristol health and wellbeing board that a full report into the research would be published in May but the interim findings raised several issues, which primarily arose when patients were transferred between healthcare providers.
She said: “Several key themes have emerged including time pressures, waiting times, staff shortage and lack of resources and repeated staff calls for more direct communication between teams. But overall a very reciprocal relationship of respect and understanding between care staff and families was highlighted.
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“Communication seemed to be lacking or confused and we have yet to find a respondent who has been offered a care plan. However, the main sticking point for many of the respondents has been the transition from one care service to another.
“We have found a suggested lack of integrated care planning or sharing of information which has caused great anxiety and dissatisfaction for some service users and their families. Detailed narratives include patients being moved without the knowledge of their relatives, patients transitioning to care homes who are unaware and unprepared for their arrival, and in one case a patient delivered unconscious in a wheelchair to a care home, refused admittance and returned in the ambulance to the hospital, all within sight of their distressed relative.”
None of the health and care providers, or the patient, has been named because the survey is anonymous. Ms Bird said she accepted Healthwatch’s data was subjective and based on a person’s experience but that it continued to suggest improvements were needed in areas such as communication and provision of basic information to patients and loved ones.
“Recommendations therefore are likely to focus upon establishing an index of patient and family understanding regarding care homes and next steps, improving communication protocols for transitions and tailoring communications appropriately,” she added. Bristol City Council's director of adult social care Stephen Beet told the City Hall meeting that the aim was always to ensure patients left hospital on the correct pathways, working in partnership with acute hospitals and other NHS providers.
But Mr Beet said pressures from the pandemic, winter, ambulance waits, ambulance queues and delayed discharges meant providers were dependent on beds becoming free and being available. This led to The Bristol Hotel in Prince Street being used as a temporary care facility recently in a bid to free up much-needed hospital beds at Southmead and the Bristol Royal Infirmary.
Patients medically well enough to leave hospital but requiring additional care before they could return home were moved there from just before Christmas following a rise in Covid admissions. Mr Beet said that as the NHS in Bristol, North Somerset and South Gloucestershire developed the model of “discharge to assess” for the future, having fully adopted it in March 2020, Healthwatch’s research was of great value.
He said: “It’s really important we hear the experience of people going through that pathway, and their carers and relatives. We try to focus on outcomes but we tend to talk about people moving through pathways in numbers rather than the voice of the individual, so it’s really welcome.
“I can help to make sure it’s heard by the right people and that it has the right impact,” Mr Beet told the meeting on Thursday, February 24.
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Also read: NHS to pay £1,200 to families to get patients out of Bristol hospitals
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