Rise in hospital readmissions is cue for fresh concern over discharges

Emergency hospital readmissions of older people have risen as
delayed discharge rates have fallen, raising concerns some patients
are being discharged too quickly.

The Healthcare Commission’s annual State of Healthcare
Report finds that while the proportion of delayed discharges
among over-75s almost halved between September 2001 and March 2003
from 12 to 6.5 per cent, the proportion needing emergency
readmission within 28 days rose from 7.1 to 8.2 per cent over the
same period.

“Older people must not be rushed back into independent living
before they are ready,” the report warns. “If they are, there may
be a greater risk they will quickly need to be readmitted to
hospital. There is some evidence that this may be happening with
increasing frequency.”

The figures follow earlier concerns that pressure on health and
social services departments to free up beds quicker could encourage
doctors to discharge patients from hospital before they are fully
ready.

Under the government’s delayed discharge reimbursement system,
which came into force in January, social services departments can
now be fined £100 a day (£120 in London and the south
east) for any patient not given a care package within three days of
discharge notification.

The report reveals that the percentage of patients aged over 75
whose discharge was delayed in each of the 28 strategic health
authorities varied from 3.2 to 15.4 per cent in England in the year
to March 2003. The highest rates were in southern English counties
such as Hampshire, Surrey and Sussex, where high property prices
squeeze out residential care, the report states.

Hospital staff should discuss home care arrangements with older
patients before discharging them, adds the report, highlighting
that this did not happen in almost a quarter of cases.

The report also says there is evidence to suggest a reduction in
age discrimination within the NHS, with the number of operations
performed on over-75s on the rise.

It criticises NHS trusts for failing to provide dedicated
facilities for treating children – one in four do not – and cites
evidence of children as young as 12 being detained on adult
psychiatric wards.

Meanwhile, the report is also concerned that black people are four
times more likely to be detained under the Mental Health Act 1983
than their white counterparts.

– State of Healthcare Report from www.healthcarecommission.org.uk