Mental Health Trusts Experience Rapid Rise In Delayed Discharges


The Law Of… preventing delays in discharging patients from hospital

Delays in discharging people from hospital are increasing rapidly in mental health trusts in comparison to other sectors of the NHS in England, according to the BBC.

Sahera Khanam, Paralegal in Simpson Millar’s Education Law and Community Care team, explains how these delays are affecting mental health patients, in particular, across the UK.

Increase of delayed discharges in mental health trusts

In October 2016, there was a 56% rise in the number of bed days lost to delays in discharging patients in psychiatric trusts in comparison to November 2015.

The NHS also revealed that in the 24 trusts across the country that specialise in mental health and learning disability care, 17,509 bed days were lost.

When Can A Patient Be Discharged?

Although hospitals have their own discharge policies, the NHS recommends that patients shouldn't be discharged from hospital until:

  • You're declared as medically fit enough to leave hospital
  • You've had an assessment looking at what support you need to be discharged safely
  • You have been provided with a care plan in writing, which details the support you'll be given to meet your needs
  • The support in your plan has been put in place and you can be safely discharged

A delayed discharge takes place when a hospital declares that a patient is medically well enough to leave its care, but something stops the patient from being discharged.

Oliver's Story

27-year-old Oliver Lang, who suffers with Asperger's syndrome, is one patient who experienced a lengthy delay in his discharge from hospital.

He was initially detained under the Mental Health Act and sent to a psychiatric unit. Weeks after he was told that he could leave the unit, however, he was still waiting to be discharged whilst 2 different mental health trusts argued over who was going to pay his medical expenses.

He ended up staying in the unit for 2 months longer than necessary.

"I felt I was in danger there because a lot of things happen in (psychiatric) hospitals. I felt if someone attacked me, I'd have to defend myself", Oliver explained.

"But if I did defend myself and hurt someone, they'd say I was a danger to the public still and they'd keep me locked up for longer. So I was trying to be whiter than white."

Underfunded And Lacking In Social Care Resources

A 2016 report from the National Audit Office revealed that delays in discharging patients in England were costing the NHS £820million a year. The Department for Health (DH) is now planning on investing around £400million over 4 years in order to support people in their homes.

Commenting on the DH's plans, a spokeswoman said: "No-one should face unnecessary delays in being discharged."

"The Five Year Forward View for Mental Health will transform services by 2020/21 to make sure urgent improvements are made."

One of the biggest problems contributing to the delays in discharging patients is the lack of social care services that are available for people once they leave hospital. This is down to cuts in funding given to local authorities and rising demand for these services.

Poor community psychiatric provisions and a reduction in a number of other services offered, such as detox, have also left mental health patients in particular at a disadvantage. Data from a 2015 inquiry ordered by the Royal College of Psychiatrists found that these 2 factors were the main reasons why patients were having to travel long distances to get hospital beds.

Responsible for requesting the research on the current number of delayed discharges, Norman Lamb, Liberal Democrat MP and the former care minister, said:

"It’s all part of a system under impossible strain. Mental health has suffered much more in terms of financial terms than the rest of the NHS, there's a discrimination."

The chief executive of the mental health charity Mind, Paul Farmer, pointed out that delays discharges can have a detrimental impact on the well-being of a patient in recovery:

"The time after leaving hospital is critical as that is when people are at the greatest risk of taking their own lives. People need the right support to recover and manage their mental health properly and trusts should be planning properly for the discharge from the point at which someone goes into hospital."

"These problems are symptomatic of mental health historically not being given the attention and funding it deserves."

Sahera comments:

"The above findings are concerning as the delays in discharge mean that some patients find themselves in a position where they are unable to access the community or resume any kind of active life, as they would have done prior to being admitted to hospital."

"This is of particular concern for patients who lack capacity and for whom the Deprivation of Liberty Safeguards are triggered as they may be unable to challenge the delayed discharge as easily as those with capacity."

"If a person is medically fit to be discharged, it is imperative that all that can be done is done to help them leave hospital as soon as possible, particularly given the risk of hospital-acquired infections."

"We often act for individuals who are compelled, under a standard authorisation, to remain in hospital for extended periods of time without adequate steps being taken by the relevant hospital discharge team and/or the relevant local authority to discharge them. Challenges to the standard authorisation may be available in those circumstances."

"However, a large part of the problem is a lack of funding for the discharge-planning services. Something needs to be done, at a national level, to remedy those issues so that vulnerable adults are not overlooked."

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