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16 October 2014

Arnish Lighthouse

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Discharge policy

Yesterday (Thursday), the board of NHS Western Isles had its monthly meeting and a plan was thrashed out to address the £2.8m shortfall on its budget. NHS Trusts and Boards all over the UK are experiencing serious shortfalls, and government policy appears to be a contributary factor.

Here in the Western isles, as I keep flagging up, gross mismanagement does not help things along. The latest concern was raised by the consultants group at the local hospital where it would appear that patients are discharged under the direction of a manager, not a clinician. At the end of the day, it is a doctor's decision whether a patient is medically fit for discharge. It is not relevant whether the hospital is running short of beds (which may well be the case after one ward was recently shut). According to the report from the consultants' group, the hospital manager (a nurse) makes decisions to discharge patients. That is cause for extreme concern all round.

As I already mentioned, the doctor will decide, upon examining the patient, whether he or she is fit to leave hospital. I don't know what goes on in the hospital wards, but if the manager exerts pressure on a junior doctor to sign the discharge form against his professional judgment, then this person is acting unprofessionally. Their own professional registration could be placed in jeopardy as a result.

Secondly, patients who are not fit to be discharged will turn up back at the hospital in short order. It is known in the trade as the revolving door syndrome. It doesn't solve anything, the patient is back in hospital, the bed is still occupied and it could possibly worsen a patient's condition.

I am relieved to hear that the consultants group has called on this practice to stop, and am actually horrified that it has been allowed to continue in the first place.

In another report out today, 23 members of staff in the Health Board (preselected by senior management) said that poor communication lay at the root of the problems currently besetting the Health Board. I think it is high time that the Health Minister took action on this matter.
Posted on Arnish Lighthouse at 14:45


You seem to be talking utter rubbish. Neither a Nurse nor a Doctor would put his or her job on the line. Iam sure that the Health Department would stamp on this at very short notice. If you really are concerned about the situation then write to the Minister of Health rather than air your views in the belief that people reading this will think you are an authority on the matter. Hospital Managers have a duty to the public to make sure that the bed state is in such that they can provide a service to the public and thus there must be a number of empty beds for emergencies. Believe me that the Managers would risk their jobs if they regularly discharge patients who are not fit to be discharged "medically" In the eyes of a layman it may appear that the patient is not fit, but indeed they may be fit. It has been proven that patients recover far better at home than in a hospital environment.

an ex islander from cornwall

Ex-islander, I could say a lot in reply. I'll be brief. The scenario I have described has led to the consultants' group objecting to the practice. Next steps will be disciplinary action if it continues. There is pressure on beds nationwide, but there are limits to what can be done to alleviate that. If you followed the state of affairs in NHS Western Isles from 1 mile away (like myself) rather than 700, you would see it's not as good as it's made out to be. Writing to the Health Minister? Read back my previous posts on the issue, and you'll get my opinion of the Minister. If you think that's going too far, double check on the whole story - all open for reading on the BBC News Scotland site.

Arnish Lighthouse from Stornoway

There's no cage-blocking at Northvet. Treatment to each cat according to owners' means. Didn't you humans used to have a similar system pre 1948? Ah yes, the good Old Days............

Flying Cat from Orkney Mainland

i would like to agree with arnish lighthouse on the NHS Western Isles Issue. Ex-Islander from Cornwall is mis informed. He should as you say read previous posts and the well publicised concerns of the employees before making cack handed comments. we are living with this grim reality unlike him. The situation with early discharge is indeed a reality and pressure has been applied to staff. I would like to appluade Arnish lighthouse for his fair reporting on this issue. my only regret is that the health department are unable to see that this island is being short changed by the Health Board. thank you arnish lighthouse for saying it as it is and for writing with the courage of your conviction. Its a pity that the scottish executive don't have your ability to see what is quite obvious to the general public.

islander from stornoway

I agree with you Arnish. I wish ex islander were right, however it seems managers push others to make ill thought out decisions without them having to take responsibilty. This is a national phenomenon. As a junior Dr working in rural north England I have experienced being shouted at by a manager in front of 24 patients and several nursing collegues after our waiting times had exceeded the government target during my night shift (thus losing the hospital money). This humiliating episode occurred whilst none of my senior collegues were present. I have also had verbal thumbscrews applied when little old ladies are not leaving hospital as quickly as management need the beds. I have been in practice for 5 years and the situation is much worse now. By the way - looks lovely up there, I might visit this summer!

happy doc from lake district

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