Cornwall hospital to discharge patients early despite saying it may be harmful

A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise.

The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved.

In a memo sent on 8 January three trust bosses said that the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”.

It had agreed a plan to relieve pressure with unnamed “health and social care partners” after discussing “ a number of possible mitigations”.

The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.

“It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.”

The message was signed by Dr Allister Grant, the trust’s medical director, Kim O’Keeffe, its director of nursing, midwifery and allied health professionals and Susan Bracefield, its director of operations.

The hospital has come under some of the most intense strain seen in the NHS this winter and has spent part of it on “black alert”, which is an admission that a hospital cannot cope with the demand for care. Some people arriving at the A&E unit have had to wait for up to 12 hours and it has asked those with minor ailments to seek care elsewhere, for example at a GP surgery or pharmacy.

The trust’s move has increased concern that hospitals are having to make tough decisions about how to respond to the intense pressures that winter has brought. The Guardian disclosed last month that the Norfolk and Norwich hospital had told its senior doctors to make “the least unsafe decision” when treating patients to help it reduce the intense overcrowding it was facing.

EveryDoctor, a network of frontline NHS doctors, voiced alarm at the Cornish trust’s plan.

“It is incredibly concerning that NHS staff are being instructed to override their expert clinical judgment for patients and provide potentially unsafe care to patients, due to a lack of resource,” said Dr Julia Patterson, the lead for EveryDoctor.

“The NHS has never had a wealth of either beds or staff; resource management has always involved intricate management of budgeting and prioritisation of patient need. This problem in Cornwall is a direct consequence of 10 long years of relentless austerity cuts made to NHS services by the Conservative government.”

However, the Royal College of Physicians said that prioritising beds and specialist care for the sickest patients would benefit those in the greatest need.

“Clinical staff make decisions on a daily basis that consider the risks and benefits to the individual patient and to other patients. Physicians will always put the safety of the individual patient they are caring for first,” said Dr John Dean, its clinical director for quality improvement and patient safety.

“For patients in hospital, if they can be safely supported at home and their treatment and recovery continued there, this should occur as soon as possible. This means that other patients can get hospital care who might otherwise have to wait and be at risk of worse outcomes.”

One doctor at the Royal Cornwall said it gets so busy that medics sometimes have to examine patients who are lying on trolleys in the A&E unit, which compromises their privacy. “There is only one outdated hospital in Cornwall. It simply cannot cope anymore.

“In A&E there are many patients lying on trollies and I am forced to examine and clerk on those trollies as there is simply not enough cubicles.

“There is a heavy workload at the moment. There are always red gaps on the rota. There is absolutely a privacy issue here, I discuss what happened to them and plans in front of many other people.”

Dr Rinesh Parmar, chair of the Doctors’ Association UK and an intensive care doctor, said: “This is morally repugnant and against the very fibre of what doctors stand for. We care for our patients and respect their dignity, not simply dispatching them early into the community to already over stretched struggling services. Our patients deserve better than these short-sighted ploys to generate beds at the expense of their health.”

NHS England has been approached for comment.