I didn’t join social work to manoeuvre people through revolving doors

By Jemma A Hughes, hospital social worker 

For every delayed discharge, there is a person with a name. This person will have experienced a change in their needs, perhaps a decline in their health or a terminal diagnosis. As a result, they may be facing decisions relating to how their needs can be best supported, where they will live and how such decisions affect them financially.

These decisions must be made and the appropriate support must be put in place within the smallest of time frames. This is not only a disservice to the person, but also to the professionals who support them. We did not join our respective professions to manoeuvre people through revolving doors. We joined, quite simply, because we care.

While the focus is undeniably tilted towards ever-decreasing time frames and bed numbers, the key role of the social care representative in these situations is to support the person and their family in making sense of the crisis that they have experienced and make a plan to move forward. Crucially, social work is not a solo endeavour; successful and safe discharges cannot be facilitated by working in isolation.

‘A deficit position’

Yet multidisciplinary team meetings are frequently being replaced with fast-paced board rounds, where estimated dates of discharge are top priority and there is little scope for debating how we can support someone to leave hospital most effectively. This change in format often results in the social care representative attending the meeting in a deficit position. This is because, as we know, there are national shortages in community, residential and nursing care.

Put simply, you must justify why a person is still in hospital or why their stay will exceed their estimated date of discharge.

If we are fortunate enough to be in a position where we can respond quickly to referrals, we often find that discharges are delayed for other reasons: medications or equipment have not been ordered, therapy is yet to take place or there are outstanding health assessments. The closure of community hospitals has perpetuated this cycle and placed remaining hospitals and staff under extra pressure to expedite discharges.

Among all of this, it is becoming more common to meet with people who attach the label of bed-blocker to themselves. How have we allowed this to happen? The vast majority of people who we support have not chosen to remain on hospital wards. These people are, all too frequently, made to feel like an inconvenience and a nuisance. Families, over-exposed to damning media headlines, appear apologetic because they cannot view prospective residential homes or make room for equipment that day, because of their own work and family commitments.

‘Exception not rule’

We would all like to see people discharged quicker but the current climate does not lend itself to this. We assess when appropriate, we commission services when they become available and we reassure people and their families that despite the pressure they may feel, we all want them to be discharged to the best possible place with the best possible support.

There is a role for creative practice here; utilising assistive technologies, voluntary services or seeking appropriate informal support from within a person’s pre-existing social network. While this is perfectly valid and valued in certain scenarios, we must remember that it is the exception and not the rule. With an ageing population and the freedoms of geographical mobility, family networks are increasingly at a distance.

We must collectively take responsibility for safe discharges. There is not one sector that should be held solely accountable for delays, nor should there be financial repercussions for a sector that cannot deliver a discharge in an allocated timescale. The most important voice in the discharge team is the service user. Time must be allowed for people to express themselves and consider all available options. If estimated discharge dates don’t consider this, then we are all forever in a deficit position, sacrificing the rights of those we support.

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