Almost a quarter of social care providers say information about discharged patients is “rarely or never sufficient”, according to a Care Quality Commission (CQC) study.
The ‘Beyond Barriers’ report, which reviewed 20 local health and care systems, found that 23% of care providers did not have adequate information about patients when making decisions about whether they could provide care to the person.
Domiciliary providers were found to be less likely to receive sufficient discharge information than other service types, affecting their ability to conduct assessments to support timely transfers of care.
CQC’s most recent report evidenced “a lack of a shared plan” had led to people not receiving the right care, in the right place, at the right time.
Consequences ranged from care being provided at greater expense, to increased pressure on services and people’s quality of life being significantly diminished.
Social care providers told the CQC that people were sometimes discharged “without sufficient information” about their medication.
They added that documents passed on by the health care workforce “did not always highlight changes to medication” or when a person “had last taken” their medication. As a result, staff said they did not know how to administer the person’s medication “safely”.
“Unless we specifically chase for information we are very rarely provided with completed discharge paperwork. It seems that freeing up a bed space is often valued more than a safe discharge,” a registered manager of domiciliary care provider told the CQC.
In addition, the report assessed the impact of delayed transfers of care (DTOC) after the Department of Health and Social Care announced a target of 3.5% reduction of DTOC rates last year.
Providers informed that pressure on local systems to reduce delays in hospital discharge had “almost overwhelmed” other health and social care priorities. Meanwhile, the CQC found examples where the focus on DTOC reduction had “compromised the safety of people” moving through services.
This included people being moved out of care settings before arrangements, such as equipment and transport, were in place for the person to return to their home.
Uninvolved and distant
While the report found evidence in places of discharge planning at the point of admission, it found that discharge dates were not being discussed early enough – with social care professionals voicing their concern about being distant in the planning stage of patient discharges.
“A focus on discharge [is] needed not only to be established early in the process, but [to be] maintained throughout the person’s time in hospital,” the report said.
Across the twenty reviews, the CQC saw positive outcomes were achieved when those working in local health and care organisations had a “shared vision” with “strong leadership” and “collaborative relationships”.
Yet, it found that barriers in effective communication meant that people’s experience of care was “too often” fragmented.
The report also highlighted “an urgent and immediate requirement” to deliver “genuinely person-centred” care, making a number of recommendations to encourage improvement.
Giving more emphasis to investing in models of care that support prevention and avoid unwarranted admission to secondary care was one of the key recommendations of the report.
To support this, the CQC said local leaders “must actively and effectively share information about people across organisational boundaries”, with national leaders needed to help enforce appropriate safeguards to maintain public confidence.
The CQC added local leaders should create an agreed joint plan for how older people are supported in their own homes, helped in an emergency, and then enabled to return home safely.
Sir David Behan, chief executive of CQC, said the findings demonstrated an “urgent necessity for real change”.
“These twenty local system reviews highlight both the barriers that prevent collaboration – and the real impact that this lack of collaboration has on older people,” he said.
“Today we are calling for those barriers to be broken down. We are making specific recommendations to local and national leaders and government… designed to encourage local systems to work together more effectively to deliver personalised care.”