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Luton and Dunstable Hospital Good

All reports

Inspection report

Date of Publication: 13 July 2011
Inspection Report published 13 July 2011 PDF

People should get safe and coordinated care when they move between different services (outcome 6)

Enforcement action taken

We checked that people who use this service

  • Receive safe and coordinated care, treatment and support where more than one provider is involved, or they are moved between services.

How this check was done

Our judgement

Although CQC asked the Trust to make focused improvement in relation to its' discharge processes in February 2011, it was a concern that practice in this area had remained below an acceptable standard. It was evident that a range of improvement activity had been undertaken and that the procedural infrastructure had been clarified, streamlined and strengthened, however this had not yet led to consistently better outcomes for people.

Communication and information sharing with the individual, care homes, families and other health care professionals remained problematic and continued to expose some people to unnecessary risks.

CQC has moderate concerns about the Trusts non compliance with this essential standard.

User experience

We did not speak with people who use this service as part of this review.

Other evidence

Following our review in February 2011 we had asked the Trust to make focused improvements in relation to the way that it managed discharges from the hospital and how it co-ordinated ongoing care or support for people leaving the hospital. The Trust responded swiftly and outlined in a report to us how they were going to address the issues and they had kept us informed of their progress.

The most recent update which was submitted on 06 June 2011 highlighted that they had worked with a range of partners to produce a revised discharge policy. This had clarified the process for making decisions about whether a patient was suitable to participate in the rehabilitation program at a local care home. It had also clarified who made the decisions about whether a patient was suitable for discharge.

We had seen the Trust's revised discharge documentation in use within a local care home and found that it contained an improved level of information about the individual. The detail was clear and provided a good overview of the individual’s needs and ongoing care requirements.

As part of the wider improvements that had been undertaken in relation to the discharge processes, the Trust had provided ward based staff with a flow chart illustrating the discharge pathway to help them understand the process more clearly. They had also introduced a revised discharge checklist in April 2011. This identified key information, advice and instructions about people who were being discharged from hospital. It included identifying where vulnerable adults would be at risk on discharge, and prompted staff to ensure that the appropriate measures were in place to protect them. This checklist was introduced as part of a new patient assessment pack across certain areas of the hospital, and the Trust had worked with its’ staff to ensure familiarity with the document and a full understanding of how it should be used effectively.

The Assistant Director / Designated Nurse for Safeguarding Vulnerable Adults from NHS Luton told us that this was a robust document and when fully embedded in practice would strengthen and enhance the discharge process. However they also stated that NHS Luton had continued concerns regarding the adequacy of discharge planning and the effectiveness of communication with other providers. It was highlighted that some people had been left at risk as a consequence of these continued difficulties.

We had also identified that a number of safeguarding referrals had been made about the impact of inadequate discharge processes. These included allegations that people had been discharged from hospital with insufficient or inaccurate information about their ongoing care and support needs. Investigations into some of these allegations had not yet been concluded. However they had highlighted continued issues with the effectiveness of the systems for sharing information with care home providers and community health care professionals. These processes continue to need strengthening in order to ensure that people are not being exposed to unnecessary risk.

The importance of ensuring that discharges were carefully planned and co-ordinated had been raised in the past with the Trust, and although it had taken a range of action to strengthen these processes, it was a concern that these safeguarding issues continued to occur.