Discharging patients from hospital without care packages in place will increase the chances of them dying, leading doctors have warned. The British Medical Association (BMA) said it rejects the guidance to "change the risk threshold" for releasing people from hospital.
The union said that while it agreed that longstanding patient flow challenges required remedy, any decision to discharge patients from wards without proper social care support would "transfer the liability and risk to clinicians". Wales' seven health boards currently have nearly 1,800 patients medically well enough to leave hospital, but many of them will still need assistance once they return home.
Dr Iona Collins, chair of the BMA's Welsh Council said: "You can't pass the responsibility for a failure to deliver services over to the hands of the doctors. We have not created this situation, and it is not for us to now put our own medical registrations on the line by making decisions that we would not make because we do not believe those decisions are safe. Patients, their families and carers will bear the consequences of this new policy, which we fear has not been risk assessed."
Her concerns come following a letter from the chief nursing officer and the deputy chief medical officer to the health boards which offered "support and advice to ensure patients are kept as safe as possible, and services are kept as effective as possible over the next period".
It said the NHS was facing exceptional pressure and there were more than 500 confirmed Covid cases in Welsh hospitals, with rapid increases in other respiratory viruses. The letter states: "We recognise that day to day clinical decision-making must adapt to these exceptional pressures, to ensure the NHS resource is being used for the greatest benefit.
"Our hospital capacity must be preserved for those at greatest risk with the greatest chance of benefit, this will require us to make every effort to keep people at home, not to admit people to hospital unless absolutely necessary, and to return those in hospital to their homes or alternative place of safety as quickly as possible."
The Royal College of GPs said it had "serious concerns" about the decision to discharge patients who need a care package before that package has been put in place. A RCGP spokesman said: "First and foremost, this presents a risk of avoidable harm to patients. Secondly, we anticipate that it will lead to even greater pressure on primary care services which are already at breaking point.
"We acknowledge that there are system-wide problems, and the shortage of beds in hospitals is also placing vulnerable patients at risk. We are keen to work with our secondary care colleagues to find sustainable solutions."
He added: "In March 2020 we were told that the NHS faced an unprecedented challenge and GPs rose to the task. To find ourselves nearly three years later, and beyond the worst of the pandemic, being told the situation is, once again, unprecedented clearly speaks to a wider problem. Unsatisfactory and potentially dangerous sticking plaster quick fixes must not become the norm. We broadly support the Welsh Government’s proposals published in A Healthier Wales and the Primary Care Model for Wales, but those aspirations feel a world away from the situation we are dealing with on a day-to-day basis."
NHS Wales chief executive Judith Paget said the decision to issue guidance to discharge without care packages was taken on a "balance of risk". "This is about us using our hospital beds for the patients who are at greatest risk. So, that will be the elderly person who's had a fall at home and is on the floor waiting for an ambulance to arrive, or the elderly person who has had a stroke and is in an ambulance outside our A&E departments," she explained.
"The balance of risk in the system is out of kilter at the moment. We really need to discharge some of our lowest risk patients in order to make way for the highest risk patients that we're not getting. So, is there a risk? The letter that has gone out from the chief nursing officer and the deputy chief medical officer is incredibly balanced in its approach. It doesn't say, ‘We'll just discharge people and don't worry about it.’ It gives a whole host of mitigations about how we can make sure that discharges are safe. It's very clear that this to be done when it's safe to do so.
"What we're seeing over the last couple of days is a really fantastic response from families when our nursing staff are ringing them to say, ‘Mum can come home, we've got a package of care, but it's not going to start for another 48 hours. Could you help by supporting them until the package of care starts?’ The response from families has been very positive. Is there always a risk? There's always a risk, in everything. This is about balance of risk and trying to minimise the risk to the most concerning patients."
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