We wanted to explore the quality of the transfer of care process in Somerset and use the experiences of people who have been discharged from hospital with ongoing care needs to guide improvements in the process.
- Efforts should be made to address the breakdowns in communication between all staff involved in a patients care and discharge.
- Communications from health and social care professionals to patients and their family/ carers requires improvement.
- Consideration should be given to the suitable transportation of patients due to be discharged. It is clear that some people still require additional support for such a journey even when they are seen to be ‘medically fit’ to be transferred. It should also be clear who will be responsible for the cost of this transport.
- The needs assessment process requires improved continuity and the consideration of a wider concern about the suitability of a patient’s situation before transferring them home.Use simple and uncluttered content and design.