"Discharge of my Nan from James' Hospital"

About: St James's University Hospital / Older people's healthcare

(as a relative),

Nan is 90 with dementia.

She was admitted to Ward 28 (Chancellor Wing) St James' Hospital with suspected shingles on.

She got great care, rapidly responded to treatment.

We visited the day after she was admitted and discussed discharge with a Nurse (who was ace), and explained discharge procedure to us saying Nan would not be discharged until everyone was happy and it was safe to do so (in conjunction with intermediate care team etc. We explicitly asked for as much notice as possible as we had temporarily suspended 2x private care companies (who go in 2 or 3 times a day)and we would need to restart these - so there would be no need to involve intermediate care team. I repeated Nan was 90, with dementia, deaf, living alone, with carers going in multiple times a day to keep her safe - and discharge would be easy to get wrong without good communication. The nurse said what we'd asked for was doable and said she would add this to the notes. I complimented her on her clear explanation of SAP/CPA and her colleagues also laughed. I then said that she knew this was the theory and was this actually the practice. She said yes it was.

A couple of days later (a sunday) we got a phonecall from the Ward at 13. 11 saying Nan was being discharged. Our Aunt had been with Nan that morning at approx 11am that morning when Nan was visited by the consultant. There was no mention of discharge at this point.

I phoned the Ward and spoke to a different nurse.

I asked if Nan's Dom care had been arranged and I was told we (her family) should do this. I asked if discharge could be delayed until this was in place, and was told Nan had had to give up her bed and was sat in the waiting area.

I said that I had specifically asked to be informed with as much time as possible, and was told t the decision to discharge was a medical one, and that the ward were under pressure for beds. I said this did not sound like patient centred care. The nurse said she believed herself to be patient centred, but that included patients that were not in front of her, and those who needed the beds as well.

She repeated we should arrange the carers to come back in again, and if there was a problem to call back, as they had special arrangements with care providers. We said that our carers were independent - not provided by Leeds CC - and perhaps this was not the case.

I asked if this was usual procedure and she said "normally this is not a problem." I said that this did not sound like the arrangements outlined to me on Friday the first nurse. she said she did not know everything that had been said by this nurse to me. I said that I had expressed concerns on Friday and has asked them to be put in the notes. I also said that with increased personalisation in Social Care, person centred care was about not making assumptions about care arrangements, and discharging before these had been bottomed out.

I explained that Nan did not have a key to her house, nor any food in. I asked what safety assessment had taken place and if Intermediate care had been involved. I did not receive an answer. I asked yes or no and still did not receive an answer.

I asked if Meds had been sorted and we were told not. I asked if there was and ETA on when they would be ready and was told "3. 30ish, we'll aim for 3. 30pm. " the nurse said that if they were not there at that time, she would arrange a taxi for them to be taken round to Nan's.

This nurse was lovely throughout, and said she sympathised, but spoke as if there was nothing she could do about this decision, or the way in which it was being handled.

When we arrived at Ward 28 at 3. 30 the meds were there and the nurse I spoke to on the phone was courteous, friendly and professional

The reason I'm giving this feedback is: we are an engaged family who care for Nan. We appreciate there is pressure on beds. We want to collaborate with clinical staff in the care of our Nan, and the way to do this is by collaboration - not by making decisions and then dumping responsibility elsewhere. I appreciate that discharge is a medical decision. This decision was made hours before it was communicated to us. Nan had already been turned out of her bed by the time contact was made with us. Ward staff made a number of assumptions about what was possible, and what was safe, rather than checking these out with us. In short, I believe Nan was discharged before it was established that it was safe to do so because of pressure on beds. In a post Francis world this should simply not happen. I could even understand this if contact had been attempted unsuccessfully.

The one person who comes out of this well in my view is the original nurse I spoke to. She was a thoughtful and pleasant nurse who wanted to make sure we understood what was going on. She also gave a very fair reflection of the discharge policy at LTHT with Patients experiencing dementia. I do not believe this policy was adhered to or followed in the order it should have been because of the need to full beds and meet KPIs.

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Response from Leeds Teaching Hospitals NHS Trust

Dear Svejk

Thank you for your feedback. We appreciate the time you have taken to pass on comments about your relative's experience. Your comments are valued.

We always strive to offer everyone a high quality experience and take it very seriously when we get it wrong. We have passed your comments to the Matron of ward 28. She is very willing to talk to you about your experiences and the issues you have raised.

If you would like to discuss the issues in person, and confidentially, you can contact the Patient Advice and Liaison Service (P.A.L.S) on 0113 2067168 or email patient.relations@leedsth.nhs.uk. If you wish they can put you in touch with the matron also.

Thank you once again for your feedback.

Update posted by Svejk (a relative)

I wrote to PALS a week ago following LTHT's reply, asking

- what action has been taken or is planned (beyond the email being passed on to the Matron) as a consequence of my feedback

- what are LTHT's thoughts are on the circumstances I've described

- how LTHT think this process might be different in the future, and what Nan should expect from LTHT next time

- the method of review LTHT uses to capture, aggregate and report such feedback through to management/Board (and perhaps an anonymised copy of the last one)

- whether or not you believe my Nan or I should receive an apology for what happened in these circumstances

Although they have yet to acknowledge my email or get back to me, I'm optimistic, as pp16 onward of http://goo.gl/0HhtK gives LTHT some clear recommendations to about how to manage the feedback they receive.

Updates, changes and questions related to this story