"Care in Tameside general hospital, a lesson around discharge planning"

About: Tameside General Hospital

(as a relative),

Recently my 75 year old mother, who has a major fear of hospitals and health services in general, had to go into Tameside General hospital for an operation. She stayed there for a week. I wanted to comment on her journey, as no doubt it wasn’t an uncommon journey for people of her age, or in her situation and there are lessons for the hospital to learn from it.

Before I get into raising issues I want to start the story by praising the hospital staff for the excellent clinical care that she received whilst she was there, from both medical and nursing staff. The ward was a calming and pleasant environment, which is a pleasant surprise these days. The furnishings were pleasant and coordinated; the ward was tidy, bright and exceptionally clean. (The food was poor though!)

My mum’s journey started way back in outpatients some months ago, where she attended for assessment. At the time my mum was extremely anxious and afraid and was struggling with the consultation. However, the lady doctor who saw her put in the extra effort and time to listen to her, explain things clearly to her and help her make a decision about future treatment. She even went out of her way to ensure mum wouldn’t have to come back for to many other sessions before the operation could happen, by doing an interim treatment there and then and booking her in for her operation, which is not the normal protocol, as you were not supposed to have the two treatments at once i.e. the interim treatment and the organising of the operation. Due to the levels of anxiety in my mum, the doctor was flexible and did both at once. It was at that time that the discharge planning and issues about the fact that my mum lived on her own with no help or support near her started and it was logged that she would require a social work assessment in order to aid her discharge post operatively, given the operation she was going to have. My mum also requested that any correspondence / appointment letter etc was copied to me, as she is so scared of hospitals that she won’t open the letters herself! The doctor indicated there was already an alert on her notes, which said this needs to happen (from a previous episode of care) and that this would be okay.

Unfortunately, despite this request from my mum, I never received any copies of correspondence, so my mum’s stress was added to when I had to get her to open the letters that had been sent to her whilst I was on the phone to her some miles away, so she could read them out to me and I could allay any of her fears that way.

The pre operative assessment went well and my mums anxieties were discussed with her in detail and it was agreed that on the day of the operation I would be able to stay with her all day, go down to theatre with her etc in order to manage her anxiety problem. Again at this point, the need for assessment post operatively, as she would have to return home alone with no support, was discussed, as the operation she was scheduled for meant that she could not lift heavy things / clean/ bend/ carry shopping etc for 3 months post operatively and so she would need help. We were reassured that this would happen on the ward and not to worry about this.

The day of admission came and the staff who booked her in for the operation and dealt with consent, explaining the operation and dong the basic final checks were excellent. Especially the anaesthetist as he went out of his way to ensure she was not pressurised into taking a form of anaesthesia that she was not happy with. The staff were all very good at dealing with her anxiety state, especially when we got to theatre and her consultant Dr Hanna and the aneasthetist met her at the door and took her in themselves.

Post operative care could not be faulted and the nursing care she received was second to none. All staff were extremely friendly and operated on first name terms with the patients which made people feel at ease and they always had time to talk to people about any issues they had.

What disappointed us was the discharge planning process which was uncoordinated and to be honest non existent. This hindered her discharge, leaving her in hospital for longer than she needed to be. This was due to mixed messages coming from different professions of the clinical team and lack of coordination, despite the discharge issues being raised with the hospital from the very first out patients’ appointment right through to the day of operation and the days that followed.

Despite frequent requests for full discharge assessment of her social care / support needs, given she was a 75 year old who lived alone with no family or support to hand, it was not forthcoming. The discharge liaison service were not contacted until we complained and presumptions were made by clinicians that just because she had visitors that she would have people to look after her when she got out of hospital, which was clearly not the case. On top of this the message from the consultant, nursing team and eventually the discharge team (when they saw her on the Friday after being in all week) were very different which added to both mums and our anxieties about whether she would have a safe discharge.

• Consultant kept saying she must have full 24 hour support for at least a week on returning home due to risks of clotting and falls (which was not possible without a package of care being put in place)

• Nursing staff felt she only needed a bit of support with lifting / hoovering / shopping / cleaning and heavy household tasks

• The discharge person felt that she didn’t need any support at all!

Clearly families cannot have confidence that the discharge is a safe discharge when the opinion is so far apart.

The fact that there was no formal multi disciplinary assessment of her needs and proper liaison with her and the family meant that her discharge was a disaster and it wasn’t helped by the consultant on the day of her discharge (clearly rattled by the fact that we had raised a complaint and asked for proper clarification) saying to her that "if it had been his mother he would have taken the time off work to look after her" implying that as a family we were not doing our duty! Or by the fact that he rang us directly starting the conversation by saying “I understand that you are refusing to have your mother home"

All we wanted was factual information about what she could and couldn’t do post operatively, a consensus on what (if any) support she would need in the 3 month post operative period given her condition and information on where to get help / additional services if necessary for shopping / safety pendants incase she fell / washing & hoovering etc. This is clearly the remit of good discharge planning for older people who live alone and whose nearest relatives are some distance away.

Sitting listening to other peoples stories on the ward, the confusions around discharge planning were commonplace and staff did not seem to know what the processes were and there didn’t seem to be anyone leading the process. I’m sure my mum’s experience wasn’t unique and is no doubt happening to many older people in hospital settings.

Apart from the discharge issues, my mum’s journey through Tameside General was excellent, it’s a shame their discharge planning processes let them down so badly and we would like the hospital to put some thought into how they can improve in this area.

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Response from Philip Dylak, Director of Nursing, Tameside Hospital Foundation Trust

Thank you very much for taking the time to write an extensive and detailed account of your mother's experiences at Tameside Hospital. I am very grateful to you, and will use this account to improve services for future patients. I am delighted that you were so pleased with the clinical care your mother received, and the environment in which she received it. However, like you, I was rather more concerned about the problems encountered in relation to the discharge planning process. The Trust has a number of structures in place to ensure safe and effective discharge, to which you refer, yet in this case, and possibly others, the process was uncoordinated and unsatisfactory. In response to these issues, I have asked the management team for the area to review this case to see what lessons can be learned and applied to future patients. I can assure you that we will indeed put some thought into how we can improve discharge, particularly for this patient group. May I conclude by thanking you once again for your comments. I am sure the staff will be pleased to learn that your mother received excellent clinical care at Tameside Hospital and I will ensure they are aware of the comments you have made. May I also wish your mother the very best - I hope she is now recovered and much improved.

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