Wednesday, 29 February 2012


In all fields of nursing there is a term that induces intense headaches. "Social Discharge". Perhaps the patient has been declared medically fit, perhaps they came in with a minor complaint that could have been resolved by a GP but some social concerns were flagged by the nurse in A&E. For example the patent may live alone and be dishevelled, unwashed and by all appearances unable to look after themselves.

Whatever the reason at some point a nurse, usually a ward nurse will have to start the social services referral process. First you fill out a "Section2" when you first identify the patient may have care needs on discharge, this is filled out before the patient is medically fit for discharge just so social services have the patient on their books and are roughly aware of what the patient may require with this you have to fill out a box entitled "Estimated Date of Discharge". Can you imagine how hard it is to guess when a patient may be ready to go home when they first present to you?

Next up the "Section 5". This is a joint work between the nursing and medical team saying the patient is medically fit. On this form you suggest what care the patient may require, residential home, nursing home, home care, caters coming into the home up to four times per day. This then gets faxed off.

That was the easy part. Now you have to get together in a room with a social worker, physiotherapist, occupational therapist, nurse, doctor, dietician, speech and language therapist and a case worker whose job it is to co-ordinate proceedings. The purpose of getting all these highly paid, highly experienced professionals in the same room is to decide who pays for this patients post discharge care. If their care needs are severe everything will be funded by the primary care trust(pct). This never happens. Of their care needs don't meet the pct requirements it's down to social services. Social Services funding is means tested. If the patient has more than £12000 worth of combined assets then the patient is required to partially find their own care.

So after completing and faxing over twenty forms and then attending this meeting which can take hours. Bare in mind a ward nurse attending this meeting has twelve patients on the ward not being looked after as well as they could be for the duration of this meeting because the nurse "holding the fort" has twelve patients of their own. What is the inevitable outcome of all this? The patient isn't suitable for state funded care and will have to stay in hospital until the family have made private arrangements.

I was sat in that meeting for two and a half bloody hours! I am a high dependency nurse my job is to care for two very sick patients. When they are more clinically stable they go to the wards. I'm lucky in that my job very rarely involves discharges and social meetings.


Vincent said...

I heard on the radio that someone wants to abandon use of the word "bedblocker" in internal NHS meetings. The Thought Police have taken over.

One assumes that every hospital patient who's medically fit came from somewhere, whether satisfactory or not. When medically fit, one would think they could be easily discharged so as to return whence they came. With few and rare exceptions.

I shall say what you don't, and suggest that government-controlled responsibility for everything that moves has gone far too far. Publicity and sentiment don't seem to be able to wind it back to something sensible.

Asclepius said...

The entire process is largely a battle between the social services and the primary care trusts about who is paying. Usually the result is the patient sits in a hospital bed for months after being declared medically fit, in that time the patient is exposed to hospital acquired infections, chest infections, clostridium difficile, etc.

We get memos around reminding us that a patient in a ward bed costs about £600/night, an HDU bed about £1000, and ITU bed about £1600. Thats assuming that patient receives no advanced medications or treatments. When our individual ward budgets shift into the red we are reminded to tighten our belts and crack down on unnecessary waste. Social services and the discharge department dont get any of this.