Scandal of patients thrown out of hospital in the night: Medic's call for 'chorus of disapproval' to end policy of sending sick people home after dark
21:54 GMT, 15 September 2012
It is late at night. On the ward, most of the patients are asleep. A few doctors mill about, writing up notes. Then, the phone rings and something happens.
The nurses wake one of the patients and start to pack her bags in the gloom. She’s going home. The bleary-eyed patient is bundled into a taxi.
It seems an unbelievable scene but it happens in hospitals up and down the country. I have rightly been asked by many concerned relatives: What on earth is going on
Figures obtained under the Freedom of Information Act show that last year, 239,233 patients were discharged from hospital between 11pm and 6am
Sick, frail patients being turned out of their beds in the middle of the night Surely this can’t be true
Not only does it happen, but it is happening more and more. Figures obtained under the Freedom of Information Act show that last year, 239,233 patients were discharged from hospital between 11pm and 6am. That means that about 3.5 per cent of all discharges from NHS hospitals took place in the middle of the night, and the number has risen over the past five years.
Isn’t there a process to ensure that patients are well enough to go home
The usual pattern for patients being discharged is that, after a morning ward round with a senior doctor when progress and investigations are reviewed, arrangements are made for them to be discharged later that day. Of course mistakes are sometimes made and things overlooked, but it’s a fairly well-oiled machine. Increasingly, however, this doesn’t seem to happen.
So who is doing this
The decision to discharge at night usually falls to the bed manager. They identify unoccupied beds in a hospital and decide which ward a patient goes to and when. When they realise that the hospital is approaching capacity, they talk to the clinical staff to identify patients who can be discharged. Those who are due to be discharged in the morning find themselves most likely to be sent home that night.
It's not just bad practice to discharge patients back home at such an ungodly hour, it's downright dangerous – and often completely pointless as they end up back in A&E in the morning, waiting for a bed.
Surely this can’t be safe
It’s not just bad practice to discharge patients – many of whom are elderly, frail and recovering from an illness – back home at such an ungodly hour. It’s downright dangerous – and often completely pointless as they end up back in A&E in the morning, waiting for a bed.
At night, it’s impossible to ensure that adequate levels of support are in place as night staff have to hand over to the day team jobs such as ensuring social services are aware the patient is home. It’s also disruptive for the patient.
How can they be so cruel
It’s easy to vilify the bed manager but their hands are tied – if there are acutely unwell patients in A&E waiting, they have to do something about it.
The four-hour rule in A&E was introduced by the Labour Government back in 2004 to limit the time people had to wait to be seen. The target means that every patient presenting to A&E must be either discharged or admitted to a ward within four hours.
Failure to deal with a patient in this time can land the hospital with a fine. In addition to this, the number of beds in many hospitals has been cut in recent years. PFI – private finance initiative – was a scheme introduced by the last Government whereby private companies rebuilt and took over the running of NHS hospitals. However, most new hospitals built under PFI have around 30 per cent fewer beds.
So what can be done
Until there is a change in policy, there is little that can be done. While the hospital has a duty of care to the patient, there is no explicit rule stipulating the time of day when a patient should be discharged. If you or a loved one have been discharged late at night and this was inappropriate, you are entitled to raise the matter with the hospital.
If enough people do this, the chorus of disapproval may speed up change. I, along with doctors, nurses and countless patients and their relatives, hope that a way can be found to put a stop to this practice.
Do you know someone who has been sent home from hospital in the middle of the night Email us at [email protected]