Agenda item

The Committee considered a report of Healthwatch Leicester and Leicestershire which presented the results of a piece of research into the patient experience of being discharged from hospital. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

Micheal Smith, Manager, Healthwatch Leicester and Leicestershire presented this item and Mark Wightman, Director of Strategy and Communications, University Hospitals Leicester (UHL) was present to answer questions.

In response to the report, Mark Wightman advised that Healthwatch and UHL worked closely together and that UHL found Healthwatch’s feedback useful.  In this case, it was being acted on by the Head of Nursing. UHL felt that the report provided a fair reflection of the discharge lounge but it was clarified that only between five and ten percent of the 180-300 patients who were discharged every day used the discharge lounge.  These were patients who were waiting for collection by relatives, medication to take home, transfer to a nursing or residential home or were waiting for transport.  If Healthwatch carried out further research in this area it would be useful to include the views of patients who were discharged straight from their ward as well.  UHL recognised the need for improvements to speed and efficiency of the discharge process and this was a key strand of its Quality Strategy, particularly as there was a need to create more capacity in Leicester’s hospitals and releasing beds was the most cost-effective way of achieving this.

Arising from discussions the following points were noted:

(i)        The research which fed into the report took place in the spring of 2019 and involved speaking to patients that were waiting in the discharge lounges at Leicester Royal Infirmary and Glenfield Hospital. It was originally intended that those same patients would be spoken to again two weeks after discharge however most of the patients spoken to did not take up this opportunity. Healthwatch recognised that it did not have the capacity to undertake an in-depth service review; the report was intended to provide a snapshot of the discharge system. Discharge was a priority for Healthwatch and they intended to conduct further research into the issue in approximately one year’s time.

(ii)       Whilst the focus was on the views of patients rather than practitioners, Healthwatch did converse with those delivering services to gain their point of view.

(iii)      The key findings from the research were that patients felt they were spending too long in the discharge lounge and were unhappy when the timetable for their discharge changed at the last minute. Patients wanted to be part of their own discharge planning. It was important to give the patients accurate expectations of how soon it would be before they would be leaving hospital and doctors needed to point out to patients that whilst they may be medically ready to be discharged they may still need to wait, for example for medicines to be issued.

(iv)      To ensure the Healthwatch research was being acted upon, Healthwatch sent representatives to the Discharge Working Group, part of the Better Care Together workstream, and the Chair of Healthwatch Harsha Kotecha attended meetings of the UHL Governing Board as an observer.

(v)       In the past when a patient was seen as part of a ward round and a decision was made that a patient could be discharged, the job of writing a prescription for that patient to take medication home with them was given to a junior doctor. However, ward rounds could take some time to complete and the writing of the prescription could therefore be delayed. To tackle this problem UHL were allocating pharmacists to ward rounds so that the prescriptions could be written and processed straight away.

(vi)      Where the UHL management team were of the view that changes needed to be implemented to systems and processes there always needed to be a dialogue between administrators and clinical staff as clinical staff would be aware of issues that administrators may not.

(vii)    It was acknowledged by UHL that having a car parking system where users paid on exit for the precise time their vehicle had been parked rather than having to pay on entry and estimate the time they would be parked for, would be of benefit to patients. However, changing the ticket machines so that they allowed users to pay on exit would be costly and UHL had to prioritise how it allocated funding.

(viii)   Healthwatch Leicester and Leicestershire would welcome having members of the public with experience of the health service being referred to them by elected members.

RESOLVED:

(a)      That the Healthwatch Leicester and Leicestershire report on Hospital Discharge be noted.

(b)      That officers be requested to provide a report on recruitment and retention of staff at university Hospitals Leicester for a future meeting of the Committee.