Working together to improve Orkney’s Health and Wellbeing – Leaving Hospital

This feature focuses on our hospital inpatient wards and in particular leaving hospital. This is the third of our regular series of patient information and updates to put the spotlight on clinical services at NHS Orkney. As an organisation, we want to share with you and be open and transparent about how we are addressing the challenges we face in supporting you. The hospital inpatient wards are under pressure and we need your assistance to help us meet your needs and to support you to take responsibility for your own health and wellbeing.  

We start this feature by asking for your support to make the best use of our hospital services.  

If you need medical advice, NHS Inform has a wealth of guidance for dealing with illnesses such as respiratory and flu symptoms, as well as other minor ailments, you can see more here, https://www.nhsinform.scot/symptoms-and-self-help/.

The Emergency Department continues to be busy and we’d like to remind everyone to only attend the Emergency Department when it’s necessary to do so. If you attend the department but do not require urgent care you will face a longer wait or be redirected to a more appropriate service. If you are acutely unwell or require urgent medical attention, please continue to call 999. If you attend the Emergency Department you will be assessed to see if you require admission to The Balfour.

We want to ensure that everyone is receiving the right care, in the right place, at the right time and from the right person. To enable us to admit people who need hospital care we need to be able to discharge patients at the right time, and this is where we all need to work together.

Delayed transfers of care happen when a patient is ready to leave the hospital but is still occupying a bed due to a wait for their care to be transferred, be that to home care provision, sheltered housing or a care home facility. We need to work together to decrease the number of people who experience these delayed transfers of care. This is not solely the responsibility of the hospital or community services but can only be achieved by us all working as partners including patients and their carers.

We appreciate that often when older people become unwell it is a very tiring time for carers and families often wish to access residential care for a relative following a hospital admission. Whilst we appreciate the reasons for this, we would never advocate that, except in very exceptional circumstances, someone is admitted to hospital and leaves to move directly into residential care. Moving into care is a massive life change and not one which should happen as a consequence of having been acutely unwell. The Social Work team will work together with the multidisciplinary team to determine a care package for a patient’s discharge to the community which meets the patient or family member’s needs. A care package will vary according to the individual but can include support to achieve personal care activities such as getting up in the morning, getting washed, dressed and having breakfast. The number of visits in the package will be determined by the needs of the individual but can include visits in the morning, lunch, tea and bedtime. Some people also need an overnight visit and to be further supported by the use of a community care alarm which enables help to be summoned from either carers or the Community Mobile Responder service (mainland and road linked isles only).   

  What we are doing at NHS Orkney to help

• Treat you as an individual and be a partner in your care
• We aim to discharge patients by 11am wherever possible. You may be asked to collect your loved ones from our “collection lounge”, this lounge is based within the Day Case Unit
• Involve you and your loved ones in planning your discharge, with discussions and assessments to support your discharge. Discharge planning begins when you or your loved ones are admitted to hospital

What we need your help with

• When you, or your loved ones, are offered a package of care, although the times may not be optimal, please accept them in the first instance as this will allow you to go home and assist us with capacity in the hospital to manage acutely unwell patients. The timings can always be reviewed when you, or your loved ones, are home. The timings of any care packages are reviewed periodically, and you can be added to the waiting list for more preferable times if you find these are not suiting your needs   
• If you, or your loved ones, require an increase in your care package, you may be asked to consider waiting for this increase in the community, if it is safe to do so, once you are discharged. This will not affect the time that you are waiting for your increase in care, but does protect against the associated risks with a prolonged hospital stay when it is not required
• Ensure you have a Power of Attorney set up both for your welfare and financial issues. Power of Attorney is not limited to people who are older or unwell. Any of us may face an unforeseen illness, accident or other debilitating event that may render us incapacitated. Setting up a Power of Attorney empowers someone of your choice to act on your behalf to ensure that your views are heard when you do not have capacity to voice these yourself. Ensuring Power of Attorney is in place can prevent lengthy waits in hospital or for Guardianship. More information can be found here, www.publicguardian-scotland.gov.uk/ 
• If forms or assessments are needed please get these done as quickly as possible to prevent delays in the process
• Adult Social Work will work with you to determine the most suitable care on discharge. If there is no alternative but for future care to be delivered within a care home your social worker will take note of your preference. If you are offered a place in an alternative care home we would ask that you accept it as there is the option to transfer to another care home at a later date. We appreciate this can make visiting difficult perhaps for a period however it is really important for either your health or that of your family member to leave hospital as quickly as is possible and return to living in a homely setting

Our teams work incredibly hard to help patients leave the hospital when they are fit to do so and by working together we can ensure the beds within the hospital are kept for those who need them most.