The report looks at the work already carried out by the PHSO (Parliamentary and Health Service Ombudsman) which highlighted harrowing cases that illustrated the human costs of poor discharge, causing suffering and distress for patients, and anguish for their carers and relatives.
Poor patient discharge can take the form of both delayed transfers of care, where patients are kept in hospital longer than is necessary, and premature or early discharge, where patients are discharged before it is clinically safe to do so, or without appropriate support in place.
The PACAC inquiry found that the discharge failures identified by the PHSO report are not isolated incidents but rather examples of problems that patients, relatives and carers are experiencing more widely. Despite increased attention to the issue, it remains a persistent problem. There is a need for more data to be gathered on the scale and impact of these discharge failures.
Whilst excellent guidance on best discharge practice is available, the extent to which good practice is implemented varies across the country. Barriers to the implementation of best practice are prevalent both within hospitals and at the interface between health and social care. Pressures on resources and capacity within hospitals are leading to worrying and unsafe discharge practices. The Committee calls upon health and social care leaders to endure that staff are operating in a culture where person-centred care is the undisputed priority.
Chairman of the Committee, Bernard Jenkin MP, says:
"Hospital staff seem to feel pressured to discharge patients before it is safe to do so. Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge."
Split between health and social care: case of political maladministration
At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. This is political maladministration. The Government has accepted the recommendations of the predecessor Public Administration Committee to merge the Local Government Ombudsman with the PHSO as part of a new and comprehensive Ombudsman Service, and this will mean that it will be able to investigate the administration of health and social care together more effectively.
The Government has also developed promising plans to tackle this structural disconnect between health and social care, including through the Discharge Programme Board, the Better Care Fund and the long-term integration policy, but they are far from implemented. The Government must take further steps to endure the integration of health and social care is achieved.
PACAC recommends that:
- The Secretary of State for Health establishes a clear set of objectives for the Discharge Programme Board, together with success measures and timelines, so that its progress can be measured
- The Government explains what is happening in parts of the country where funding for the Better Care Fund from the New Homes Bonus does not materialise
- The Government set out a route map demonstrating how arrangements for long-term, sufficient, sustainable and integrated funding for adult social care will be implemented, by March 2017
- The Government set out a clear plan for implementing integrated health and social care plans across the country, as pledged in the 2015 Spending Review.
The predecessor Committee's report of the 2014-15 session, "Investigating clinical incidents in the NHS", has resulted in the Government establishing the Healthcare Safety Investigation Branch (HSIB). The Committee expects his emerging body to play a major role in investigating serious incidents of unsafe discharge, to learn lessons from each case, and to ensure that learning is disseminated and implemented throughout the NHS.