Why do the NHS do this? Big waste of time and resources surely

[treatsortreating]

I've had a few unlucky times in the last year. And a few before that

Literally every time (I have 3 fairly local
Hospitals). They all do the same thing

Ward round, doctor says you can be discharged, you're good to go.

But you're waiting HOURS for a discharge letter? 8 hours on from being told I was okay to go home. Buzzed nurse again. This time someone else as hand over had been done. 'Oh yes you can go, but we're just waiting on your discharge letter'

I don't understand it? I really don't.

Why don't they post it? It can be done. My DC has a serious issue with something and a very good yet a bit further away hospital always see her. I take her to them as they're great (Addenbrooke's, Cambridge)

They never discharge her and then make us wait for discharge papers. Those get posted. Simple.

Surely this method of making people wait for discharge letters is taking up beds? Someone could've had my bed over 8 hours ago and still I was waiting

I was still unwell so couldn't put up much of a protest but it just seems an insane waste of time

Have you ever waited for meds as well ? You're not going home till five O' Clock .

I've been referred to a hospital. Said hospital suggests I go to a different one which is nearer to me and has a shorter waiting list. I have to see the GP to ask them to refer me....taking an appointment I shouldn't need. There's no sensible thinking going on.

We used to do a handwritten discharge letter. Took 2 minutes. Could complete it on the ward round. 95% of patients had a letter at the time of discharge. Another piece of paper for discharge medication. Quick and easy. They forced us to switch to an incredibly buggy prone to freezing electronic discharge system, and forced us to prescribe discharge meds on that. If you're really lucky, and there's a functional computer free, it takes a good 20 minutes with no interruptions per letter, longer if it needs meds on it. And it can't be done on the ward round because 1)it takes too long so the ward round never gets done, and 2)the only mobile computer is being used to look up blood results, check xrays, order tests, for the other patients. Bloody nightmare. If they'd let us use old technology we could get them ready much faster, as we proved, but senior management just wants to flog the workers for a crappy new system taking longer than a good old system. But then, the old system was actually designed by clinicians. The new one was designed by IT teams, who never even spoke to us.

Happened both times I gave birth. Hospital desperate for beds, me desperate to leave but hours waiting for paperwork.

Please do feel free to get a job in your local hospital. The NHS is chronically understaffed. Of course if you did that you might realise that the delivery of healthcare is enormously complex and the NHS actually does a massive amount with sod all.

The discharge letter you hold in contempt could be giving you medication advice, safety netting if you deteriorate, follow up guidance. All worth you knowing. Your gp likely gets an electronic version yes but you are waiting for your version to keep you as well as possible. And yes when you're waiting the doctor is doing at least 20 other things.
So if you're the well patient going home then you are the lucky one. Because some people don't get to wait for a discharge summary. The least you can do is have the gratitude and grace to wait until the doctor is able to sort it out for you.

Let me give you one example. My child has to have regular appointments to get fitted for a medical device. They send out a letter in the post. It often never arrives so I get told off for missing appointments but how am I supposed to know if they've made me an appointment if I don't get the letter? Then sometimes we can't make the appointment they give us (usually due to a conflicting hospital appointment elsewhere). So I call the lady in the department who sends out the letters. She says she will send me another appointment letter in the post. She refuses to tell me when the appointment is for so that I can check we can make it. So I wait a week or so for the letter. Sometimes it arrives and we can make the appointment. Sometimes it doesn't so I have to call her again. She will then sometimes tell me the appointment time verbally but only with a lot of huffing and puffing. If we can't make that appointment she says she'll put another letter in the post. And on and on it goes. So much wasted admin time, so many wasted appointments, so much wasted postage costs. And that's just one small example. And I can't be the only one who experiences this. Multiply it with all the other patients experiencing the same thing and it's ridiculous.

Same story with returning things like crutches. I spent hours and hours trying to arrange to bring back crutches after my child had surgery. No one would take them. I ended up giving them to the NHS physiotherapy centre as at least they would be reused again. I suspect most people wouldn't bother. £££ wasted.

This is all true, but why does the letter have to be physically given to the patient, why not email it? And why do meds need to come from the hospital pharmacy? Just give the patient the prescription if they are willing.

@whenemmafallsinlove You misunderstand we are totally grateful of our care , more than grateful .We just really want to get out of your hair . Until the next time we see you again 😄.

This isn't patients vs doctors. No one is holding discharge letters in contempt! Or ungrateful for medical care. We are pointing out the mad inefficiencies that both make doctors jobs much harder and impact on patients. Surely we are all on the same side in that?

At the Trust I work for we now send all discharge letters electronically to the GP. This is automatic; as soon as the dr clicks finish off it goes. You can wait for a copy if you so wish, and if it's available we will give it to you with your medications. We can also post a copy. But no one really stays for the letter alone. There's a huge push on ensuring all discharge medications are ordered well in advance, it's rare to be waiting for discharge medications. We also have a discharge lounge as PP said for people who are waiting to be collected. This frees up the bed. I have to say in the time I've been here (5+ years) the process has been well refined and improved greatly.

We also have a drop off point outside the main building where equipment such as crutches and walking aids can be returned without having to park and go into the hospital itself.

Discharge letters may contain immediate actions that you need to take once home that you have not been doing previously. For example information on a new medication to take or social care referral instructions. The copy of the letter going to your GP ensures they are not wasting time and money prescribing old medication. If all nhs trusts and GP practices used the same systems then you wouldn’t need a discharge letter - but they don’t!

The NHS is a shitstorm of inefficiency.

so the consultant saying "you can go" is only a small part of the discharge process. junior doctors, nurses, pharmacists and other allied healthcare professionals then have to make sure you are actually safe to go home. in many cases, there will be no other issues to consider - the limiting factor becomes a very overwhelmed junior doc writing the letter and the meds being ready (pharmacy is always SO busy and then porters have to bring the meds to the ward to be checked). but in other cases the associated issues can take MONTHS to sort out.

the hospital has a legal responsibility to ensure that you are "safe" to go home which includes adequate provision for home treatment/followup.

sure things can be improved in many cases, but resources are very limited

@therealcookiemonster resources are indeed limited, but in that case it needs to be accepted that that's the harsh reality and not pretend to offer a competent health service. Because the pretence just means people sitting around waiting forever for something to happen, which quite often doesn't happen - e.g. an ambulance arriving in time to save your life.

Or a diagnosis or operation soon enough to save your life.

Let's stop pretending it's all about plucky doctors and nurses. Behind the scenes, behind the front line, absolute shit is happening. Look at maternity 'care', look at what happens to whistleblowers.

Every procedure is there because someone screwed up and a procedure had to be set up to prevent it happening again.

It's an irritating, bureaucratic system, which still goes wrong

Once upon a time, there would be ward clerks and secretarial staff who would help, there would be porters and more dedicated pharmacy techs who would just put together discharge packs

All these staff are Band 2 - currently working at £11.48ph

That's 4p an hour more than the NMW

If only there was a way of recruiting more junior staff to free up the medical staff's time

In the meantime, a discharge letter is for any changes in meds, what the hospital supplies and what the GP has to continue after discharge

It's an important document and the patient needs it

You can take out your own cannula but won’t leave the hospital once you’ve been discharged? I agree that if you’re not waiting for medication (the pharmacy are so busy that they can take hours to process what you need), you can just tell a nurse that you’ll be leaving.

I’ve done that multiple times, both times on the postnatal ward too. The discharge letter gets sent to my GP so it’s not an issue. I thought that all discharge letters get uploaded onto the NHS system so that GPs can access them if need be?

We do need to remember that maternity is not the only dept. that treats women too , don't discount and ignore them too .All depts of NHS treat women .

I had fantastic care in both my labours and after.

Blame management and the fact managers come from business not from the ranks of the NHS.

They will have looked at the cost of posting and decided it is cheaper if people take their letter home with them.

Trust me most NHS workers get it. One hospital I worked in decided they would pay overtime to laundry services as it was the same workload every week so could be done Mon - Fri. It just about worked until the Easter weekend.

I sat waiting with my DM for two or three hours after they said she could be discharged once, she's been in hospital many many times and we've had to wait for meds or letters or the physio or whatever, so not unusual, but on this one time after a while I went up and asked the nurse what we were still waiting for and they said "we're trying to arrange hospital transport" - when I've been with her all day, car keys in hand.... Well then, this whole weekends when she's had to stay in because something doesn't happen on a Saturday or a Sunday, so we have to wait for Monday, once they did discharge on a Sunday and then I had to do a 60 mile round-trip to pick up some drugs that they weren't able to dispense until the pharmacist was back on Monday. Then there was the time that they sent a commode to an empty house - despite me being down as a carer and having contacted them many times and being backwards and forwards on the ward, they hadn't told me it was arriving so I couldn't be there to accept it, so she couldn't be discharged. I do find some hospitals are better than others though at coordinating things. I'm sure people working in these systems find them just as frustrating as those of us who are patients and carers within them.

treatsortreating Don’t know if this happened in the hospital you were in but did they strip the bed and remake it with clean sheets whilst you were waiting for your discharge letter

Saw this happen each time someone left hospital

After person left nurses would then come and strip the bed again and make it with a 2nd lot of clean sheets

Did ask the nurses why as it was just a waste of resources and time and none of them could see a problem with it which was the most worrying.

I agree. Such a waste of money. And worse still the irony of by self discharging you are considered a criminal and put on a red flag with a mw. It's just so stupid, so money wasting, no wonder nhs is dying.