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Patient discharges 'not always safe' across region, CQC warns

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Patients in Oxfordshire “did not always receive safe discharges home”, a report by the Care Quality Commission has revealed.

375_lgc_hsj_reporting

375_lgc_hsj_reporting

Health Service Journal reports that the regulator has published a local system review of how well the county’s health and social care providers work together.

During its visit at the end of November, it found multiple problems with the inpatient discharge process. The report said delayed transfers of care peaked at 39.9 delayed days per 100,000 over summer 2017. Although it has dropped since then, the rate is above the national average.

The review found:

  • Some people were discharged between 2am and 3am, which the CQC said was “unacceptable”.
  • “Some discharges may have happened too soon” – compared to the national average, lengths of stay in hospital were shorter but readmissions were higher throughout 2016-17.
  • The effectiveness of discharge services had “declined” over the last two years with 80 per cent of people over 65 still at home 91 days after discharge compared to national average of 82%.
  • “Widespread concerns” regarding provision and accuracy of discharge data. Over half of social care providers that responded said they did not receive discharge summaries for over 50% of the patients referred to them. Some letters gave no information that patients’ medicines had been stopped.
  • Over 71% of discharges were unplanned, according to data supplied by South Central Ambulance Service Foundation Trust.

The report showed emergency services in Oxfordshire were under pressure. Escalation processes had become “normalised among frontline staff” with the region operating at levels three or four on the OPEL framework for 80% of November and December. The report added: “Some leaders and frontline staff we spoke with voiced concerns that planning for winter had been left too late.”

The review also found there was “little collaboration between system partners”. Although relationships had improved after historically being “difficult”, there were still “deep rooted issues in respect of organisational culture [and] trust”. However, it said following recent changes in leadership there was a “more open culture” in the region.

The CQC was told Oxfordshire was working towards an integrated care system but found “no evidence of commitment from partners to drive this, or a plan to achieve it”.

The review also found the region was “particularly challenged” with recruitment and workforce retention, with staff reporting “heavier workloads” as a result of understaffing.

Despite this, frontline staff were “dedicated to providing high quality, person centred” care. The CQC recognised organisations were looking to solve workforce shortages through innovation in new roles and care models, as well as working with councils to address affordable housing.

The region was also praised for good, but limited, examples of joint working through the better care fund and other initiatives.

The review covered Oxfordshire CC, Oxfordshire Clinical Commissioning Group, Oxford Health FT, Oxford University Hospitals FT, South Central Ambulance Service FT, local voluntary groups and services users.

The Department of Health & Social Care asked the CQC to undertake 20 local reviews of health and social care integration across the country. So far, it has published 10 of the resulting reports.

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