Matter for Discussion: Location for care

Members can view a recording of the debate here.

Increasingly, where, how and by whom patients and their families are cared for is determined not by which service or professional is best placed to understand and respond to the challenges the patient faces, but by where there is space for them. 

The location in which patients and their families receive care can have far-reaching consequences. If they are not in a location to meet their needs, then they may face increased emotional distress. In the longer term, health outcomes may be compromised, and patients and their families may become reluctant to engage with and seek the support from health professionals and services. 

The challenges of appropriate locations of care not only impact on the patient and their loved ones but can also cause major difficulties for staff working throughout the health and social care sectors. Across settings, specialties and ages, professionals everyday face what can feel like impossible decisions about where a patient will be cared for. 

Examples of inappropriate locations of care are: 

• Young adults being unable to access age/developmentally appropriate care as they transition into adulthood due to a lack of equivalent specialist provision being available in adult services (McDonagh and Viner, 2006; Campbell et al, 2016). 
• Staff who work in hospice and end of life services are familiar with receiving patients too late, while staff in acute services are familiar with patients having to stay too long (Kirk and Fraser, 2014; Price, McCloskey and Brazil, 2018). 
• Young people presenting with significant mental health challenges being placed in acute care settings or in generalist provision (RCN, 2013; Care Quality Commission, 2018). 
• Prison nurses can describe the reality for people with learning differences and disabilities and mental health issues who are being detained in custody suites (Durcan, 2021). 
• Nurses who work in emergency departments care for patients on trolleys for hours, while their paramedic colleagues try to care for people in ambulances as they await assessment or possible admission (Gaughan et al, 2019). 
• In neonatal care, problems exist in service provision, location of services and transfers of care (Villeneuve et al, 2018). 
• Older people and those with additional care needs frequently have to stay in hospital beyond their medical requirements because they have nowhere else to go, or they are discharged into an unsafe environment (Parliamentary and Health Service Ombudsman, 2016). 

The reasons behind these inappropriate care locations are complex, and it might be agreed that the pandemic and subsequent restrictions made things worse. But it has always been a struggle to ensure effective care is delivered in the most appropriate location and by suitably qualified staff. 

This matter for discussion has been tabled so that Congress can consider the issues and the scope of the problem and start to find practical solutions.

Reading lists for each agenda item can be found here.

References

Durcan G. (2021) National Consultation and Review. https://www.centreformentalhealth.org.uk/publications/future-prison-mental-health-care-england (February 2022)

Gaughan J. Kasteridis P. Mason A.  et al (2019) Why are there long waits at English emergency departments? http://eprints.lse.ac.uk/102571/1/Gaughan2019_Article_WhyAreThereLongWaitsAtEnglishE.pdf

Kirk S. and Fraser C. (2014) Hospice support and the transition to adult services and adulthood for young people with life-limiting conditions and their families: a qualitative study. Palliative Medicine 28 (4) 342-352. Transition to adult services - Together for Short Lives

McDonagh J. and Viner R. (2006) Lost in transition? Between paediatric and adult services. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382525/ (February 2022)

NHS for Scotland (2011) Preventing infection in care. https://lx.iriss.org.uk/sites/default/files/resources/script_-_providing_care_most_appropriate_place.pdf (February 2022)

Parliamentary and Health Service Ombudsman (2016) Report of investigations into unsafe discharge from hospital. https://www.ombudsman.org.uk/publications/report-investigations-unsafe-discharge-hospital (February 2022)

Price J. McCloskey S. and Brazil K. (2018). The role of hospice in the transition from hospital to home for technology-dependent children-A qualitative study. Journal Clinical Nursing 27 (1-2) 396-406

RCN (2013) Lost in Transition. https://www.swswchd.co.uk/image/Clinical%20information/Transition/Lost%20in%20Transition%202013.pdf (February 2022)

Campbell F, Biggs K, Aldiss SK, O'Neill PM, Clowes M, McDonagh J, While A and Gibson F (2016) Transition of care for adolescents from paediatric services to adult health services, Cochrane Database of Systematic Reviews, Issue 4. Available at: Transition of care for adolescents from paediatric services to adult health services - Campbell, F - 2016 | Cochrane Library (Accessed April 2022)

The King’s Fund (2020) What’s going on with A&E waiting times? https://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters

Broad KL, Sandhu VK, Sunderji N and Charach A (2017) Youth experiences of transition from child mental health services to adult mental health services: a qualitative thematic synthesis, BMC Psychiatry, 17. Available at: Youth experiences of transition from child mental health services to adult mental health services: a qualitative thematic synthesis (Accessed April 2022)

CQC (2018) Are we listening? Review of children and young people’s mental health services, Care Quality Commission (Guildford). Available at: Are we listening? A review of children and young people’s mental health services

British Association of Perinatal Medicine (2017) Neonatal Transitional Care - A Framework for Practice (2017) A BAPM Framework for Practice Available at: Neonatal Transitional Care - A Framework for Practice (2017)(Accessed April 2022)

Villeneuve E, Landa P, Allen M (2018) A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. Health Serv Deliv Res. 2018;6(35). Available at: NIHR Evidence - Reconfiguring neonatal services balances survival chances against increased travel for families - Informative and accessible health and care research (Accessed April 2022)