"Winter pressure on bed spaces putting patients at risk."

About: Ayr Hospital / General Surgery

(as a relative),

After clinical diagnosis from an admission in November my dad was to return early january for a major op to include removal of a tumour in his bowel, a kidney and his gall bladder! ! All clinical staff encountered were great and the nurses on his wards both in November and January, fantastic..

However there are two things which need to be addressed, I will highlight them here for public consumption, but I will also be contacting the chief exec of Ayrshire & Arran, NICE, and any relevant Scottish health body for answers.

First, how is it that a 76 year old man who has just had major surgery from which the clinical expectations discussed in November were that he would be in hospital for 3 weeks be released into the community after only 1?

Expect upto 1 week in HDU and 2 weeks on ward but actually 1 day HDU and 6 days on ward. Granted HDU was very busy with some very sick people, in fact the whole hospital was busy and to be fair my dad was very keen to get out as he is also primary carer for my mum. The surgical team assembled to operate on my dad obviously did a great job with my his op and I am truly thankful but why should this hard work be undone by a failed discharge?

I believe it failed on several counts:

1. Supported by his own GP, he was discharged too early.

2. Having been discharged early evening, he was left by the front door, cold and tired, waiting for a taxi for nearly an hour. His first cab had a puncture on route and it was a while before another came, though I believe the taxi company called the hospital to advise of this nobody thought to get my dad back in the warm with perhaps a cup of tea? He eventually got home at gone 9 o'clock at night...exhausted!

3. Nobody in the community was informed of his early release. And no package set up to ensure his wellbeing as a result?

There had been an expectation that when stable enough dad would have been transferred to his own village community hospital to further recoup estate and be monitored. This didn't happen and again on discussion in November dad was told he had to rest as much as possible and a care plan would need to be set up on his release to help him for a while.

The intention, and indeed the delivery of service right up to the point of discharge was admirable however the post discharge is dismal. This cannot be levied at a community trust equally pressured by bed blocking and budget cuts but at a clear and obvious lack of communication between acute trust and community resulting in the failed discharge of my dad as outlined above.

Whilst I appreciate that as an acute trust you have experienced a perhaps unprecedented demand on your services recently, your need to juggle bed spaces and admissions should not be to the detriment of existing patients who end up being shunted out in to a community Ill equipped to deal with them to suit the political paymasters or target driven budgets.

The clinical staff should be allowed to care for patients to give each one the best outcomes possible without new admissions forcing them to discharge obviously unwell people at the behest if target driven non clinical managers. Surely if the point comes where people are being put at such high risk deaths will occur a line should be drawn and the hospital refuse to take any more patients in the grounds it would jeopardise those already under its care?

All the time the trust is seen to be coping or crisis managing the paymasters will do nothing to alleviate the pressure on frontline staff and patients alike. If there is a need for more beds, staff then they need to know and fix rather than cover it up in such a dangerous fashion. This is happening across many overstretched trusts not just Ayrshire and Arran who are presumably doing the best they can with a "bad hand" perhaps.

In any case my dad contacted his GP and arranged for the district nurse to come and remove his staples..! But a less communicative person may not have been so lucky. He has been home a week now and nothing has been set up, though I believe it will be shortly, at our behest, to help him or see how he is. As I said and I'm sure you will agree, clearly, a failed discharge...

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Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran

picture of Eunice Goodwin

Dear Fngale,

May I say how sorry I am for all the distress this has caused you and your family? Not only did you have the worry over your Dad’s condition and operation, recovery etc. the last thing any family needs is to have discharge issues.

This has been an extremely busy time with unprecedented demands on beds and I sincerely apologise that this may have impacted on your Dad and his expectations of his care. I am also sorry that your Dad’s expectation of a short stay in your local community Hospital was not met. I do know that there is a big piece of work looking at the situation with the winter pressures and the hospital flow ongoing because you rightly point out, the winter does cause issues for the Health Service.

From your post, it does seem that there was poor communication between primary and secondary care and that does need addressed to ensure your Dad has continuity of good care. To look into this and endeavour to prevent this happening to others, I would really appreciate if you would contact me and let me know your father’s name, address and date of birth.

If you do wish to contact me, you can email me on eunice.goodwin@aapct.scot.nhs.uk or phone me on 01563 826222. Alternativel you, with your father’s consent, may wish to contact our complaints team on 01292 – 513003. If there is anything further I can do, please contact me using the details above.

I hope your Dad is recovering well now and gets the best of aftercare we can provide.

Best wishes


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