Frontline views

Health and social care practitioners and a patient describe how Portsmouth’s hospital discharge and rehabilitation system is reducing bed-blocking

Sharon Hollins: “If people are in their own homes, they can relearn skills”

The hospital social worker’s view

Sharon Hollins has been a senior practitioner in Portsmouth Council’s hospital social work team for four-and-a-half-years.

Before qualifying as a social worker in 1994, Hollins was an occupational therapy assistant at the Queen Alexandra Hospital so she understands it well. She says delayed discharges have declined over the past six months as a result of changes in the process and the development of strong personal relationships.

“It’s the leadership, it’s the fact we talk more with our health colleagues about how we can get the right referrals at the right time,” she says.

“It’s also the fact that people are meeting each other, doing updates. It’s also having the enabling services out there. People do well in their own homes.

“The environment is false in hospitals but, if people are in their own homes, they can relearn their skills.”

Day-to-day contact is crucial with the clinical staff, she adds. “We will be phoning the ward, monitoring the situation, talking to ward doctors, staff nurses daily, ringing different wards discussing where we are at. Also, we work very closely with discharge planners.”

Working so closely together also helps to foster an understanding among health colleagues about what social workers do and what procedures and legislation they work under. However, there are differences in professional outlooks, which can lead to delays, particularly with regards to mental capacity.

“Ward staff are worried about risk and don’t realise that, if a person has capacity, they can choose to leave when they like,” she adds.

Roy Brown: Victory Unit helped to restore his confidence to live independently

The patient’s view

Roy Brown, 73, was in hospital twice last year, the second time as a result of a liver infection in May.

He had come to the notice of social services at the start of last year after a referral from his sister who had become concerned about his welfare.

On the second occasion, he was in hospital for three weeks. When he came out, he went to the Victory Unit rehabilitation centre for seven weeks to help regain his independence.

Before his discharge, an occupational therapist from the Victory Unit visited him at the hospital to assess his needs.

He went there because he felt he needed to regain his confidence as a result of being at the QA.

Now he is at home and has recovered so well that his file has been closed but, without that initial help, Brown does not believe he would have been able to look after himself.

“Social workers used to visit once a week, then once a fortnight and then once a month and then at Christmas they said they would be closing the case,” he says.

“Obviously it was helpful because we [my social worker and I] used to have chats about things and she made sure I wasn’t running out of food.”

Gillian Gould (left) and Nicola Martin believe less bureaucracy will speed the discharge process

The nurses’ view

“The people on the ground are there for the patients, however differing the priorities and the political tensions. That’s the most important thing and we try to cut through the who’s paying for what, which often is at the root of it,” says Gillian Gould, head of nursing in medicine for older people, rehabilitation and stroke at the Queen Alexandra Hospital, Portsmouth.

Despite this positive outlook, Gould and her colleague, Nicola Martin, senior nurse for discharge services, admit problems can arise, particularly when trying to join services together for complex cases.

The answer is to cut out more bureaucracy and to make the discharge process slicker, which is something the hospital is considering.

Gould recalls a male dementia patient who was admitted to the Queen Alexandra in the middle of the flu outbreak after Christmas.

He was medically fit to leave but both social care and health care felt he was eligible for continuing care funding, which can take a week to be agreed.

“Everybody agreed that in this man’s case it was detrimental to him to stay in the hospital,” says Gould. “What we were able to do was work with social care, the hospital, community staff and the PCT, which co-ordinate continuing care funding, to agree that he could go to an appropriate care home where his needs could be assessed in a more appropriate environment, and that happened within 24 hours.

“That wasn’t a one-off. I know over that winter period that was happening quite regularly.”

More on health and social care practitioners’ work to tackle delayed discharges in Portsmouth, including a video

This article is published in the 10 February 2011 edition of Community Care under the headline “A cure for bed blocking”

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