Agenda item

Maxine Dennis, Interim Director of Patient and Service Utilisation, Rotherham Foundation Trust, reported that, due to the pressure and demand on hospital beds and the need to be able to accommodate the admission of acutely ill patients, it was important that the hospital could expedite discharge where the patient no longer needed to be in hospital.  Whilst it was important to discharge patients in a timely way it was equally important that the discharge was safe and that patients who had complex discharge needs had their needs carefully planned for and executed.  As a result, the Rotherham NHS Foundation Trust had a comprehensive and detailed Discharge Policy which had been systematically reviewed.

There would always be some patients who experienced a delay to their discharge.  The Delayed Discharge Act clearly defined the criteria for reportable delayed discharges and the Trust, working closely with the Council, had a low rate of reportable delayed discharges.

The Discharge Policy pulled together all potential complex issues in order to ensure that any discharge or transfer of care was safe and effective whilst keeping the patient/family needs at the centre of the decision making process.

Discussion ensued with the following issues raised/clarified:-

-          Rotherham Hospital dealt with approximately 70,000 inpatients a year – admitted for planned procedures or emergencies.  This figure did not include any patients that were admitted via outpatients, day surgery, medical day assessment or Accident and Emergency.  An additional 75,000 attended A&E

-          An increase seen in the number of patients attending hospital.  Last year 7.6% increase in emergency admissions and this year already a further 5% increase additional to the 7.6%

-          The increase in admissions was significant for the frail elderly persons category. They required a complex discharge plan not just involving the Hospital but across all social care providers

-          Rotherham worked in partnership with Primary Care and Social Care colleagues and, as a result, performed very well and had low percentage of reportable delay discharges.  However, there were still a number of patients whose discharge plans were very complex and took time to discharge

-          It was important that once a patient was fit enough for discharge it was expedited in a timely manner

-          “Out of hours” was defined as discharge no later than 10 p.m. but depended upon patient choice.  Vulnerable patients would not be discharged in an evening

-          Approximately ¼ of discharges were out of hours (which included weekends)

-          Reports were received on failed discharge where a patient or other provider felt that the Hospital had failed.  Another measure was how many patients were readmitted within 24 hours, 7 days and 28 days.  Currently that ran at 10% which did not mean that the Hospital had failed in that 10% but needed to understand the reasons why the patient had returned to hospital.  There was no external scrutiny of this

-          A patient may return to hospital due to the Hospital’s failure but it may also be due to the failure of other parts of the care plan

-          Once a patient had been deemed medically fit for discharge currently it was a medical consultant in charge of that person’s care who would authorise discharge.  Work was currently taking place on where a patient had a plan of care and it had been completed and deemed medically fit for discharge, a Nurse or Doctor qualified to make that decision could authorise discharge

-          Some of the reasons for delayed discharge was due to family choice

-          Re-admission rates were monitored by CQC – details could be supplied

The Chairman suggested that at the next meeting, to be held at the Hospital, a spotlight review take place on this issue with appropriate representation invited.

Resolved:-  (1)  That the report be noted.

(2)  That Select Commission Members e-mail the Scrutiny Manager with issues they would like to discuss further at the spotlight review to be held on 13^th June.