Health board reprimanded for poor hospital discharge

NHS Dumfries and Galloway to pay for care home fees after failing to involve patient in decision

Originally published in Holyrood Magazine

Newton Stewart – credit Andy Wright

NHS Dumfries and Galloway is being forced to apologise to a patient and pay his care home fees after he was discharged to a care home without being informed of the cost.

According to the Scottish Public Services Ombudsman (SPSO), the patient, known as “Mr A”, was not informed about the financial implications following his discharge from Newton Stewart Hospital into a care home.

Mr A was awaiting surgery at the hospital, but it was decided the procedure would be too clinically complex. He was discharged into a care home but a support agency worker, known as “Mr C”, raised concerns about his discharge to the ombudsman.

In their report, the SPSO said: “Had Mr A known that the operation would not be possible he would not have allowed himself to be discharged to the nursing home. Instead, when Mr A was discharged, he believed that he would be able to return home after a short time in the nursing home following the operation.”

The Scottish Government released a report on “Treatment Time Guarantees” earlier this month. The report said: “It is entirely appropriate for clinicians to take a ‘wait and see’ approach to certain medical conditions. Investigations may be deferred for appropriate reasons and immediate surgery may not always be the preferred option. Such delays are entirely justifiable based on medical indications.”

A Scottish Government spokesperson said: “The SG issued revised guidance on choosing a care home on discharge from hospital in December 2013. The guidance is clear that patients, family or proxy’s should be fully involved in discussions about future long-term care needs, and choice of care home. We expect all local NHS boards, local authorities and Integration Authorities to adhere to these directions and guidance.

“The NHS does an excellent job in the overwhelming majority of cases, but on the occasions where it does fall short of expectations, Boards must listen and act. It is absolutely right that the Board apologises for the failures in care in this case and should act on the Ombudsman’s recommendations as a matter of urgency.”

The SPSO has given NHS Dumfries and Galloway till the of December 22 to write a formal apology to the patient and to ensure all staff involved with the discharge are aware of policy relating to informed consent and patient-centeredness surrounding discharge options.

No alternative discharge options, such as home care, was considered for Mr A and he did not receive any advocacy services to assist him with this complicated decision.

The SPSO said: “We found that the board failed to take all reasonable steps to ensure Mr A was in a position to make an informed decision about the move to a nursing home and that an opportunity for discharge home was missed.”

According to the Patient Rights Act (Scotland) 2011: “The right that the health care they receive should consider their needs, consider what would be of optimum benefit to them, encourage them to take part in decisions about their health and wellbeing, and provide information and support for them to do so.”

The health board told the BBC: “NHS Dumfries and Galloway acknowledge the SPSO findings and we are considering our response at this time.”

The SPSO has given NHS Dumfries and Galloway until the January 22 to pay Mr A’s care home fees as part of NHS Continuing Care.

Galloway and West Dumfries Conservative MSP Fin Carson said he will meet the chief executive of the health board tomorrow.

“Discharge from Hospital into the community is a very stressful time. Everything need to be done to ensure that patients are well informed and aware of the choices available. This sadly, has not been the patient’s experience in this case.

“Cottage Hospitals such as Newton Stewart Hospital,  can play a vital role in rehabilitation and subsequent transition from hospital to home or residential care, particularly in rural areas where support can move easily be provide by family and friends.”

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