Experience of hospital discharge

The five North London Healthwatch organisations worked together to explore patients' experiences of hospital discharge from Whittington Hospital. Through telephone interviews, they spoke with nine people discharged during the second half of 2017, including three family members speaking on behalf of patients. The interviews examined discharge information, care planning, support at home and areas where discharge arrangements could be improved. 

Experiences of discharge were mixed. Some patients felt well informed and supported, particularly those whose existing care arrangements resumed smoothly or who required little follow-up support. Others reported a lack of notice about discharge dates and times, leaving patients and families feeling excluded from plans. Several family members said they would have appreciated clearer communication and more advance warning to help them make arrangements for collecting relatives and preparing for their return home.

Views on care planning also varied. Some patients felt their wishes were respected and that they were consulted about their ability to cope independently at home. Others reported feeling excluded from decisions, particularly around reablement services and changes to care arrangements. Family members sometimes felt that important decisions about equipment or support needs were made without sufficient consultation. 

A number of participants described positive experiences following discharge. The respiratory team, cardiac nurses, district nurses and GPs were highlighted as providing valuable support. However, some respondents experienced delays in obtaining equipment, therapy assessments or other services needed after discharge. There were also isolated reports of medication errors and confusion about treatment arrangements once patients returned home

The strongest concerns related to reablement and home care services. Patients and families described a lack of continuity, with numerous different care workers visiting throughout the week. Some felt carers were overly focused on tasks listed in care plans and unable to respond flexibly to changing needs. Concerns were also raised about missed visits, variable staff attitudes, poor communication and uncertainty about charging arrangements once reablement packages ended. 

Most participants supported the principle of "discharge to assess", where longer-term care needs are assessed after a patient has returned home rather than while they are still in hospital. Respondents felt assessments at home allowed professionals to understand practical challenges more accurately and offer tailored advice about daily living, mobility and equipment. Several said assessments should take place shortly after discharge, once patients had settled back into their home environment. 

Overall, the report found examples of excellent support following discharge, but highlighted the need for better communication with patients and families, more involvement in care planning, greater continuity within home care services and clearer information about reablement arrangements and charges.