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25 pensioners discharged at night every week from hospitals in Northern Ireland

Patients discharged at night
Patients discharged at night
Dr Ian Crawford
Pat Cullen

By Lisa Smyth

Almost 5,000 elderly people were discharged from Northern Ireland's hospital wards in the middle of the night over the last three years, it can be revealed.

And an average of 25 pensioners were discharged from hospitals between the hours of 11pm and 6am every week last year, according to official figures.

This is despite guidance from the Department of Health, issued in 2014, which states that no frail and elderly person should be transferred or discharged from hospital after 8pm without the permission of the patient or their family.

However, figures released by the health trusts in response to a Freedom of Information request suggest people are still being inappropriately discharged late at night.

The statistics have highlighted the ongoing issues arising from the growing staffing crisis and a reduction in the number of acute hospital and community beds across Northern Ireland.

In total, 13,139 patients were discharged from hospitals here between the hours of 11pm and 6am from April 2016 to March 2019.

The figures do not include the likes of women leaving hospital after giving birth, and discharges from foetal assessment units, ambulatory wards and transfers between hospitals.

Organisations representing doctors and nurses have said staff are under continuing pressure to discharge patients to free up beds for emergency admissions, as well as people who are waiting for planned surgical procedures.

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Dr Ian Crawford

Dr Ian Crawford, vice president of the Royal College of Emergency Medicine in Northern Ireland, said: "A variety of respected organisations and individuals agree that there are few situations where it is reasonable to discharge a patient from a hospital ward at night, unless it is both safe and the express wish of the patient.

"Healthcare providers must not compromise this basic principle to free up beds for those patients who are spending ever longer in ever more crowded emergency departments in the face of bed occupancy running at or beyond 100% in core specialties, such as general internal medicine and care of the elderly.

"To ensure adequate functional capacity, our Department of Health must increase staffing, the number of acute hospital beds and the social care that are fundamentally required."

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Hospital discharges

The figures have shown an improvement in the number of elderly people being discharged from hospital overnight.

In 2016/17, 1,941 people over the age of 65 were discharged between 11pm and 6am and this fell to 1,303 in 2018/19.

However, the Royal College of Nurses (RCN) said more needs to be done to address the issue.

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Pat Cullen

Pat Cullen, the director of the RCN in Northern Ireland, said she is aware of a number of strategies within trusts to try to improve discharge planning and specifically to try to ensure safe and timely discharges for patients.

She explained: "Nurses are at the forefront of delivering these strategies and there have been many improvements in this area.

"However, we can see from these figures that unplanned and untimely discharges are still occurring.

"The RCN does not believe that it is ever acceptable to discharge any patient, but particular elderly and vulnerable patients, during the night.

"Nurses can be put under pressure to discharge or transfer older, vulnerable patients in order to accommodate equally vulnerable patients.

"This can lead to significant stress for patients, families and nursing staff.

"The RCN believes that greater investment in community nursing would result in older people being supported to receive care in their own homes and reduce pressure on the wider health and social care system."

Dr Tom Black, chair of the British Medical Association's Northern Ireland Council, said there are some occasions when it is possible to discharge patients overnight.

However, he stressed that this should only be done when the appropriate support is in place in the community, and with the agreement of the patient.

The issue of overnight discharges hit the headlines in 2012 following an investigation by The Times, which prompted the then NHS medical director Sir Bruce Keogh to launch an investigation amid fears for the safety of vulnerable patients.

A subsequent report by the Parliamentary and Health Service Ombudsman found a series of distressing examples of elderly patients being discharged inappropriately at night.

On one occasion, an 85-year-old woman with dementia was discharged at 11pm without her son being informed.

The following morning her daughter found she had been left with no food, drink or bedding, unable to care for herself or get to the toilet.

The Health and Social Care Board, which is responsible for commissioning services, did not respond to a query over whether there are any plans to increase bed capacity in Northern Ireland.

A spokeswoman said: "In November 2014, guidance was issued by the Department of Health to all Health and Social Care Trusts that no discharge or non-medically indicated transfer for frail elderly patients in acute hospitals should happen after 8pm without the agreement of the individual and their family that discharge is voluntary or required to ensure the patient receives appropriate clinical care.

"Such decisions should always be taken in the best interest of the patient and on an individual basis, in discussion with the patient and their carers."

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