12 In and out of hospital Time and again they are seeing inadequate In-home assessments consideration given to what will greet a patient “ Often it's about getting them well enough to when they get home as a result of the pressure be able to go home but actually in the home to free up beds. is often what’s causing the decline in health “They let her home, she didn't have any food. because of the way that they are living and She'd been in there for two months, so all the the lack of support at home. So if [only] you food in the fridge had all gone mouldy, there could see what they’re like at home and was no food there. She'd got home, nobody assess them.” to help her.” Community nurse, Bradford Red Cross team member In-home assessments were frequently Red Cross volunteers and staff also spoke mentioned by the Red Cross staff and about people being transported home from volunteers as well as health and social care hospital, only to be left in their car park, unable professionals we spoke to as being crucial to make their way inside. to ending a continuous cycle of hospital “ He’d actually been sent home eleven o’clock readmissions. at night. The ambulance had dropped “ And people we see have just come into him in his car park on his crutches, and hospital because they've had a fall and driven away.” broken their hip, and then we turn up after they've been discharged… there's no gas, Red Cross team member there's no electric, they're living in a messy Assisting patients inside their home provides an house; they've not really been coping getting opportunity to check their home environment. their food, they've just been getting by. ” Checking their home is safe would likely help Red Cross volunteer reduce the number of emergency readmissions within 48 hours of discharge, reported to make All too often, the professionals and Red Cross 12 volunteers and staff we spoke to saw scenarios up more than one in five readmissions. Others pointed out that pressure to free up where older or vulnerable patients were sent beds could sometimes result in qualified home without the right care in place, only to nursing or occupational therapists being return to emergency departments. diverted away from their substantive roles to “ When she went into hospital, they kept do discharge planning. sending her home the same day, but she was Sometimes care packages have been still living in the same squalor, nobody was organised, but due to pressures in social care, there to support her. The final thing we know they are not adequately implemented: is that, she had one more fall…” Red Cross team member “ A lot of the time, the care agencies are so stretched that they can't actually meet the There was a sense among some professionals needs that are required on the actual referral, that there are now fewer in-home assessments so the ward might say she needs – or the because of financial and capacity issues. social worker might say she needs four times a day carers, but actually the care agencies “ Five or ten years ago, this kind of patient we can't provide it, so carers don't show up, or would have probably have done an access they might need a double visit but only one visit, where we go out and look at that [their carer can go – it's constantly happening, home]. We don't do them as much now constantly happening. ” because we just don't have the time.” Falls prevention team nurse, London Occupational therapist, Manchester 12 Healthwatch, What do the numbers say about emergency readmissions to hospital? (October 2017).