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‘Political maladministration’ contributes to unsafe discharge from hospital

Posted on 29th September 2016

The Public Administration and Constitutional Affairs Committee (PACAC) has followed up the Parliamentary and Health Service Ombudsman (PHSO) report on unsafe discharge from hospital by accusing the government of ‘political maladministration’ in failing to tackle the structural disconnect between health and social care.

The summary from the report is reproduced here:

“PACAC received a report of investigations into unsafe discharge from hospital by the Parliamentary and Health Service Ombudsman (PHSO). This highlighted nine harrowing experiences that illustrate the human costs of poor discharge, causing suffering and distress for patients, and anguish for their carers and relatives.

Our inquiry found that the discharge failures identified by the PHSO report are not isolated incidents but rather examples of problems that patients, relatives and carers are experiencing more widely. Despite increased attention to the issue, it remains a persistent problem. We identified a need for more data to be gathered on the scale and impact of these discharge failures.

We heard that, whilst excellent guidance on best discharge practice is available, the extent to which good practice is implemented varies across the country. Barriers to the implementation of best practice are prevalent both within hospitals and at the interface between health and social care. We heard that pressures on resources and capacity within hospitals are leading to worrying and unsafe discharge practices. We call upon health and social care leaders to ensure that staff are operating in a culture where person-centred care is the undisputed priority.

A lack of integration between health and social care is preventing seamless discharge processes, coordinated around the patient’s needs. The NHS must support local areas to adopt the best models of integration.

At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration. The Government has accepted the recommendations of our predecessor Committee to merge the Local Government Ombudsman with PHSO as part of a new and comprehensive Ombudsman Service, and this will mean that it will be able to investigate the administration of health and social care together more effectively. The Government has developed promising plans to tackle this structural disconnect between health and social care, from the Discharge Programme Board to the Better Care Fund and long-term integration policy, but they are far from implemented. The Government must ensure that these plans are set out clearly and supported by sustainable funding arrangements, so that they may be effectively delivered.

Fundamentally, the problem of unsafe discharge requires high levels of trust and openness between leadership and staff, to ensure that staff are empowered to make the decisions that put patients, their relatives and carers first. We expect the Healthcare Safety Investigation Branch (HSIB) to play a major role in investigating serious incidents of unsafe discharge and to ensure that learning is disseminated and implemented throughout the NHS.”

Read the full report.

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