Section 2 hospital discharge notice
Discussion
Evening, a bit of a long shot here.
My grandmas in hospital after a number of small strokes. She was discharged a few weeks ago, but ended up back in less than a week later as her health declined and she caught pneumonia. When they discharged her, there was no discussion, no one was available to collect her so after half a day in a waiting room with no care, food, drink of sanitary assistance they put her in a hospital minibus and drove her home.
Anyway she's back in now, has been for a couple of weeks. Yesterday they said a section 2 notice had been issued and they were planning on discharging her. Having done a bit of digging, I understand they should only complete a section 2 after an ongoing care assessment has been completed. No one has mentioned anything about this, I also believe they should provide a copy of the section 2 notice.
My mum asked to see a copy today but they refused on the grounds of data protection. Now given my grandma can't talk (or walk, or stand for that matter) following the strokes, is it really realistic to expect her to be in a position to request it?
I've suggested my mum writes a letter of request and get my grandma to sign it.
Have any of you been in a similar situation or have any suggestions? We genuinely don't believe she is in a position to be sent home, and I don't thin it's unreasonable to expect her care needs to be professionally assesses and provisions put in place to ensure some sort of continuity before she is booted out.
My grandmas in hospital after a number of small strokes. She was discharged a few weeks ago, but ended up back in less than a week later as her health declined and she caught pneumonia. When they discharged her, there was no discussion, no one was available to collect her so after half a day in a waiting room with no care, food, drink of sanitary assistance they put her in a hospital minibus and drove her home.
Anyway she's back in now, has been for a couple of weeks. Yesterday they said a section 2 notice had been issued and they were planning on discharging her. Having done a bit of digging, I understand they should only complete a section 2 after an ongoing care assessment has been completed. No one has mentioned anything about this, I also believe they should provide a copy of the section 2 notice.
My mum asked to see a copy today but they refused on the grounds of data protection. Now given my grandma can't talk (or walk, or stand for that matter) following the strokes, is it really realistic to expect her to be in a position to request it?
I've suggested my mum writes a letter of request and get my grandma to sign it.
Have any of you been in a similar situation or have any suggestions? We genuinely don't believe she is in a position to be sent home, and I don't thin it's unreasonable to expect her care needs to be professionally assesses and provisions put in place to ensure some sort of continuity before she is booted out.
Quite, that's exactly my point, they sent her home last time with apparently no continuing care assessment. My granddad ended up in himself a couple of days later as an indirect result and she contracted pneumonia and ended up going back. We obviously don't want a repeat of this.
All the hospital are interested in is freeing up beds, its quite apparent they don't give a s
t about what happens to the people when they leave.
All the hospital are interested in is freeing up beds, its quite apparent they don't give a s
t about what happens to the people when they leave.A section two notice is a referral to social services - it should have been discussed with you or your relative - in fact there is a tick box on there that states "Is patient / family aware of referral?"
In complex discharges it is advisable to get the ball rolling sooner rather than later, it may be that extra help is required or placement (temporary or permanent) in some form of care facility may be on the cards. Hospital social workers are very overworked and there is the need for length of stay in hospital to be reduced due to both financial and clinical priorities.
In my field (trauma and orthopaedics we routinely refer patients for social work assessment on admission if we feel that there may be a problem with discharge.
Good luck, if you need any further advice please PM me.
SD.
In complex discharges it is advisable to get the ball rolling sooner rather than later, it may be that extra help is required or placement (temporary or permanent) in some form of care facility may be on the cards. Hospital social workers are very overworked and there is the need for length of stay in hospital to be reduced due to both financial and clinical priorities.
In my field (trauma and orthopaedics we routinely refer patients for social work assessment on admission if we feel that there may be a problem with discharge.
Good luck, if you need any further advice please PM me.
SD.
It turns out a student nurse ran through it and signed it on behalf of my grandma. It states my grandma has no communication issues... She currently cant string a sentence together...
yesterday they suggested she wouldn't require an ongoing care assessment as that was only for people with complex needs...
she currently has issues with her liver, heart, she has diabetes, cant string a sentence together and can't walk... So her needs are fairly complex!
the whole things a disgrace!
plus the consultant had no notes at all from when she was last admitted to hospital. Lucky my mums keeping notes.
yesterday they suggested she wouldn't require an ongoing care assessment as that was only for people with complex needs...
she currently has issues with her liver, heart, she has diabetes, cant string a sentence together and can't walk... So her needs are fairly complex!
the whole things a disgrace!
plus the consultant had no notes at all from when she was last admitted to hospital. Lucky my mums keeping notes.
Ah, from your OP I assumed she was on her own.
How well is your grandad? While it sounds shoddy could he have convinced them he could cope? He'd need to be able to help your gran transfer out of bed onto a chair or commode and help her wash and possibly eat but it wouldn't be unusual.
Obviously when he went in a couple of days after her previous discharge that all fell apart. So this time they're getting SS involved in preparation and if their needs are mostly social then SS will do any ongoing assessment.
There should be meetings to discuss her care (MDT - multi-disciplinary meetings) which the family should be able to attend to discuss concerns re management. This assumes your grandparents aren't trying to shut you out for reasons of independence/family feud etc etc...
How well is your grandad? While it sounds shoddy could he have convinced them he could cope? He'd need to be able to help your gran transfer out of bed onto a chair or commode and help her wash and possibly eat but it wouldn't be unusual.
Obviously when he went in a couple of days after her previous discharge that all fell apart. So this time they're getting SS involved in preparation and if their needs are mostly social then SS will do any ongoing assessment.
There should be meetings to discuss her care (MDT - multi-disciplinary meetings) which the family should be able to attend to discuss concerns re management. This assumes your grandparents aren't trying to shut you out for reasons of independence/family feud etc etc...
By all accounts none had spoken to my grandad. There's no way he could handle her on his own. Is the process set out anywhere? We seem to be making progress now they've twigged we are aware of the process around the section 2 notice and ongoing care assessment but the more we know the better.
It's becoming apparent that they take advantage of people's lack of knowledge to push people out of beds.
It's becoming apparent that they take advantage of people's lack of knowledge to push people out of beds.
I previously worked (about 7 years ago) in Social Services as admin support. My experience was the Section 2 and Section 5 notification forms were the formal communication between the hospital and social services that there is someone who will require care after discharge, the 2 was a 'heads up' and the 5 was a 'person ready to go' with each having clear timescales and response processes, there was nothing on these of use to a family member.
On receipt of a 2 a Social Worker was allocated a referral to visit the person to carry out assessment (or re-assessment if already known to social services with a previous care package) to identify the individuals care needs (meals on wheels, day centre, home care, respite or long term care etc).
Information sharing allowed for social services to involve family members in this assessment process. The Social Worker would then organise the packages with the agencies/providers the 5 then putting the plan into action later that day or the following morning when the person was discharged.
The Social Worker would provide the admin support with the written care package and plans which we'd then input onto the computer system (also triggered financial processes) and send the assessments to the required care agencies/providers plus family members of what had been arranged etc.
Ongoing reviews then took place to allow the Social Worker to pick up new cases and ensure that the level of care originally identified was still appropriate.
If the hospital are sending section 2's they have done their bit, they are pushing people out of beds often too soon (experienced with own family members) so you need to get in touch with the Social Services department to find out what they are doing as they can delay discharge if they believe the person is not ready to go back into the community.
Edit - the hospital and social services each carry out their own assessments for differing purposes.
On receipt of a 2 a Social Worker was allocated a referral to visit the person to carry out assessment (or re-assessment if already known to social services with a previous care package) to identify the individuals care needs (meals on wheels, day centre, home care, respite or long term care etc).
Information sharing allowed for social services to involve family members in this assessment process. The Social Worker would then organise the packages with the agencies/providers the 5 then putting the plan into action later that day or the following morning when the person was discharged.
The Social Worker would provide the admin support with the written care package and plans which we'd then input onto the computer system (also triggered financial processes) and send the assessments to the required care agencies/providers plus family members of what had been arranged etc.
Ongoing reviews then took place to allow the Social Worker to pick up new cases and ensure that the level of care originally identified was still appropriate.
If the hospital are sending section 2's they have done their bit, they are pushing people out of beds often too soon (experienced with own family members) so you need to get in touch with the Social Services department to find out what they are doing as they can delay discharge if they believe the person is not ready to go back into the community.
Edit - the hospital and social services each carry out their own assessments for differing purposes.
Edited by StevoCally on Monday 3rd February 19:13
hadenough! said:
It turns out a student nurse ran through it and signed it on behalf of my grandma. It states my grandma has no communication issues... She currently cant string a sentence together...
yesterday they suggested she wouldn't require an ongoing care assessment as that was only for people with complex needs...
she currently has issues with her liver, heart, she has diabetes, cant string a sentence together and can't walk... So her needs are fairly complex!
the whole things a disgrace!
plus the consultant had no notes at all from when she was last admitted to hospital. Lucky my mums keeping notes.
The poster above sums up the stuff aobut S.2 and S.5 notices , given the time it takes for many social services to pull their fingers out S.2s are sent a soon as is practicable to start the process lumbering ... yesterday they suggested she wouldn't require an ongoing care assessment as that was only for people with complex needs...
she currently has issues with her liver, heart, she has diabetes, cant string a sentence together and can't walk... So her needs are fairly complex!
the whole things a disgrace!
plus the consultant had no notes at all from when she was last admitted to hospital. Lucky my mums keeping notes.
NHS Continuing Care ?
you've basically got to be be Stephen Hawking to get NHS continuing care funding ...
NHS continuing care is for people who would otherwise be cared for in an acute hospital as their care needs are so complex a 'good' general Nursing home would struggle with their needs and dependencies ... often these people need either specially trained ( to add additional skills) carers and/or Registered Nurses in near constant attendance to be safe.
When I worked in the NHS in a tertiary specialist rehab unit only a small proportion of our patients were eligible for NHS continuing care , here's a few examples
- a young quadriplegic chap whose neck injury also basically wrecked his ability to swallow and protect his own airway - he was likely going to be tube fed for a number of years based on the progress of his swallow over the year he was in rehab on discharge he required someone who could do deep suction and assisted coughing to be availalbe to him 24/7
- a late middle aged chap who sustained a C2/3 injury and had pre existing bad sleep apnoea - he required nightt time ventilation and a carer who could do deep suction and assisted coughs
- a young lady who suffered a spinal cord infarct while pregnant - leaving her a C5 quadriplegic - her care needs were complicated by becoming a new mother during her rehab, meaning firstly she wasn;t able to complete her rehab , secondly being a new mum and a quad is hard enough for an 'experienced' patient never mind someone who is incompletely rehabbed and new to being someoen with a spinal cord injury.
we also had a head injury rehab unit on site and only a small proprtion of their patients got NHS continuning care funding for similar reasons.
some links
Patient targetted
http://www.nhs.uk/chq/Pages/eligibility-assessment...
http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=1...
professional targetted documents - including the checklist which defines the level of dependency and care needs required for Continuing care assessment to be commenced
Edited by mph1977 on Monday 3rd February 20:13
mph1977 said:
...
NHS Continuing Care ?
you've basically got to be be Stephen Hawking to get NHS continuing care funding ...
NHS continuing care is for people who would otherwise be cared for in an acute hospital as their care needs are so complex a 'good' general Nursing home would struggle with their needs and dependencies ... often these people need either specially trained ( to add additional skills) carers and/or Registered Nurses in near constant attendance to be safe.
When I worked in the NHS in a tertiary specialist rehab unit only a small proportion of our patients were eligible for NHS continuing care , here's a few examples
- a young quadriplegic chap whose neck injury also basically wrecked his ability to swallow and protect his own airway - he was likely going to be tube fed for a number of years based on the progress of his swallow over the year he was in rehab on discharge he required someone who could do deep suction and assisted coughing to be availalbe to him 24/7
- a late middle aged chap who sustained a C2/3 injury and had pre existing bad sleep apnoea - he required nightt time ventilation and a carer who could do deep suction and assisted coughs
- a young lady who suffered a spinal cord infarct while pregnant - leaving her a C5 quadriplegic - her care needs were complicated by becoming a new mother during her rehab, meaning firstly she wasn;t able to complete her rehab , secondly being a new mum and a quad is hard enough for an 'experienced' patient never mind someone who is incompletely rehabbed and new to being someoen with a spinal cord injury.
we also had a head injury rehab unit on site and only a small proprtion of their patients got NHS continuning care funding for similar reasons.
some links
Patient targetted
http://www.nhs.uk/chq/Pages/eligibility-assessment...
http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=1...
professional targetted documents - including the checklist which defines the level of dependency and care needs required for Continuing care assessment to be commenced
I'm aware of the info in the links - but otherwise very interesting... NHS Continuing Care ?
you've basically got to be be Stephen Hawking to get NHS continuing care funding ...
NHS continuing care is for people who would otherwise be cared for in an acute hospital as their care needs are so complex a 'good' general Nursing home would struggle with their needs and dependencies ... often these people need either specially trained ( to add additional skills) carers and/or Registered Nurses in near constant attendance to be safe.
When I worked in the NHS in a tertiary specialist rehab unit only a small proportion of our patients were eligible for NHS continuing care , here's a few examples
- a young quadriplegic chap whose neck injury also basically wrecked his ability to swallow and protect his own airway - he was likely going to be tube fed for a number of years based on the progress of his swallow over the year he was in rehab on discharge he required someone who could do deep suction and assisted coughing to be availalbe to him 24/7
- a late middle aged chap who sustained a C2/3 injury and had pre existing bad sleep apnoea - he required nightt time ventilation and a carer who could do deep suction and assisted coughs
- a young lady who suffered a spinal cord infarct while pregnant - leaving her a C5 quadriplegic - her care needs were complicated by becoming a new mother during her rehab, meaning firstly she wasn;t able to complete her rehab , secondly being a new mum and a quad is hard enough for an 'experienced' patient never mind someone who is incompletely rehabbed and new to being someoen with a spinal cord injury.
we also had a head injury rehab unit on site and only a small proprtion of their patients got NHS continuning care funding for similar reasons.
some links
Patient targetted
http://www.nhs.uk/chq/Pages/eligibility-assessment...
http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=1...
professional targetted documents - including the checklist which defines the level of dependency and care needs required for Continuing care assessment to be commenced
Edited by mph1977 on Monday 3rd February 20:13
I've posted about my wife's condition before (she is quadraplegic, PEG-fed, can't swallow or speak but is continent, her chest is her weak point and pneumonia is regular with subsequent hospital admissions) and I am her Full Time Carer. She is CHC-funded 
; about all I don't do for her is deep suction, and it has been mooted on previous admissions that I might be trained to do so (it hasn't come to pass, but I suspect it is imminent)...I'm a GP Receptionist/Administrator with a fair bit of medical knowledge - and a good bloke to have around in a crisis
- but have had no further training for this Carer role and the local district nurses (who are not inspiring or confidence-building in any way as well as being very short-staffed 
) are happy to leave me to it 
! My wife's carers (2 of them 4 times a day) are pretty good
- especially in comparison to the district nurses who seem anxious to not call at all ever again (and let me do all the wife's meds for evah it seems) 
...I have a pulse-oximeter and a timpanic thermometer and rang 999 in a timely fashion on Saturday afternoon as the wife began to deteriorate with yet another bout of "?aspirational pneumonia" - the Doctors in A&E congratulated me on this fast response
and she is doing OK on a ward now. The district nurses visit once daily and don't have this equipment - they have missed burgeoning signs of pneumonia twice now (but not on the last occasion).I shouldn't need - or be expected - to do this s
t?Apropos nothing, really, but food for thought - thanks
.PS Unfortunately, there are no "direct payments" (taking some of the CHC funding for care and using it to arrange one's own care) when funded by CHC (in Bolton, anyway) as opposed to being funded by "care" (social services) where "direct payments" are available
, so I can't tailor care specifically for her - rather, I am stuck with what is on offer, that's all folks .PPS Bolton CCG don't pay for "specialist seating" (Bury and Wigan - either side of us - do) and we had to appeal as far as NHS England before it was bounced back to Bolton CCG who have now bought her the essential Neuro Chair, which was initially promised to arrive at home in September and would have probably saved us a couple of recent admissions to hospital. The joys of the NHS postcode Lottery...
Interesting times...
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