Transfer of Care Hub: Current Discharge Pathway Report

The Transfer of Care Hub (TOCH) project group were keen to commission a qualitative report on the lived experience of discharge pathways in Thurrock. This briefing has been produced to capture the lived experience of both professionals and patients to help inform opportunities for service transformation and change. 

Healthwatch Thurrock had received many calls from patients, their families and carers, raising concerns about the discharge procedure following a stay within an acute setting across the Mid and South Essex area, including those discharged from acute mental health settings. The voluntary, charity and providers of care services within Thurrock have raised concerns around the inequality of the lived experience of patients at point of discharge. 

They developed two surveys to which 52 people responded.

Feedback from professionals

The most common theme cited by different professionals working in the same system is clearly highlighted as communication. This is the biggest barrier to effective discharge and the key to the discharge system working well. 

The feedback from professionals allowed us to identify that there are other concerns that could present as obstacles for good communication to always happen, and that could lead to unsafe or failed discharges. Some examples are lack of capacity, lack of understanding around all the different processes each team has to complete for a discharge, an increase in local demand, lack of staff and pressure to discharge. This  also meant that some professionals felt there was not a holistic approach within the discharge system, which can lead to a fragmented experience for both the professional and the patient. This fragmentation has presented as patients being discharged without the right medication, inappropriate equipment or aids, discharge papers, or referrals into community services. Without these elements to someone’s discharge process being in place, it can become harder for some professionals to provide continued care for a patient in a seamless manner, in turn making some jobs more challenging. 

An increase in local demand, pressure to discharge, and lack of capacity within hospitals has created an environment where it is not possible for effective communication to take place, preventing a streamlined discharge system 100% of the time. All of the professionals who took part were able to provide us with examples of when the discharge system has worked well, and it was evident that all professionals wholeheartedly strive to provide safe and successful discharges 100% of the time. 

Feedback from patients

The patient feedback that we received was extremely varied. This can be attributed to multiple factors such as which discharge pathway a patient was on, the patient’s expectation, the complexity of needs, and the amount of support they have around them from family members and carers. All of this feeds into the need for a holistic approach to be the ever present goal at all times to make sure that the patients’ needs are met at each stage of the discharge process. 

It was difficult to distinguish between feedback around a patients care in hospital, and just obtaining feedback around their discharge alone. It was evident that whilst professionals are aware of the ‘medically optimised’ not ‘fit’ criteria – patients are not aware of why they are now being asked to leave hospital sooner than they may feel appropriate, and why conversations around leaving hospital happen so early on. Patients may need reassurance that they are being sent home in a safe condition to alleviate their concerns. Many patients received less than 24 hours’ notice of discharge meaning they did not have sufficient time to organise travel or care. This can be linked back to the theme of communication we spoke about in the professional’s summary – and that the need for good and effective communication is always essential.

It is important to note that there were many cases where issues occurred due to a patient being a Thurrock resident being discharged from Southend or Broomfield. The merger of the three MSE Hospitals should in an ideal world not be felt in a negative way by the patient at hand and should receive a seamless service irrespective of which site they are seen at. 

However, many of the people were extremely happy with their discharge process and felt that everything was in place for them to return home safely or to be moved to a new place of care.