During the final months of her life, there were several occasions when Pam Waller was carried into her bungalow by ambulance crews in the middle of the night.
The 83-year-old, who had dementia and was unable to use a lavatory or feed herself, would be propped up in her armchair alone in the dark.
Alarming though it sounds, Pam’s case is not a one-off. Ambulances are increasingly being used at the dead of night to decant sick and distressed people, not into the care of doctors and nurses but out of hospital and back to their homes.
Last week an investigation revealed that almost a million hospital patients have been sent home in the middle of the night over the past four years.
Overnight discharges have risen from 220,000 in 2012-13 to 250,000 in 2015-16, according to Freedom of Information data from roughly half of hospital trusts — and the total figure is likely to be far higher. This equates to 700 people discharged between 11pm and 6am every night.
Social care cuts mean that frail patients can be stuck in hospital after finishing their treatment because they do not have help to return home. But as wards fill up, they may be discharged in a rush to free up beds when patients with an urgent problem need to be treated.
Many of those sent home are elderly, confused and living alone — the people most likely to have long-term illness, but least likely to complain.
Pam, of Chingford, East London, is a case in point. In late 2011 and early 2012, the former factory worker was repeatedly discharged from hospital at night. ‘She had Parkinson’s disease as well as dementia, and was regularly collapsing at home though we didn’t know why,’ recalls Pam’s daughter Angela Little, 63, an office worker, who lives in Stevenage, Herts.
Angela was trying to fund an extension to her home for her mother when Pam’s health problems became critical.
Each time she fell, neighbours would call an ambulance to take Pam to A&E. After being examined and admitted to a ward for a few hours, doctors would take the view that she did not require hospital treatment, and send her back home in an ambulance, Angela says. Angela was never informed by the hospital what was happening.
‘I found myself driving the 45 minutes to her house regularly in the middle of the night and finding her in a terrible state.
‘I would badger the hospital to get her a proper diagnosis so we could find out what had caused her to fall. But they said this was not a medical issue and that her care was down to social services, though sometimes she was back in hospital within two hours of being sent home.’ Angela says her mother was discharged at night ‘about ten times’ in total.
‘By the end I managed to get her taken to a different hospital after a collapse. We found she’d had several strokes and a heart attack during these previous collapses. None had been diagnosed.’
The treatment of Pam Waller, who died in March 2012, was investigated and criticised by the Parliamentary and Health Service Ombudsman (PHSO) in a report in May this year.
Whipps Cross Hospital, in Waltham Forest, East London, issued a statement apologising for Pam’s treatment and saying things have changed:
‘Following communication with Mrs Little we have worked with our partners in the community to ensure that professionals, including hospital and social care staff, meet patients and family members to discuss and meet ongoing care needs of vulnerable people before their discharge home.’
But cases like Pam’s are becoming more common.
Complaints recorded by the PHSO earlier this year and re-investigated by the public administration and constitutional affairs committee (PACAC) in September, showed hundreds of people are removed from overcrowded hospitals every night.
They are often returned confused and disorientated to their doorsteps in night clothes and without vital medication. Fridges will be empty and central heating off.
Among the cases highlighted by the ombudsman, was a woman in her late-90s discharged without proper examination, who died in her granddaughter’s arms moments after being dropped off by an ambulance.
Another confused 84-year-old was discharged into an empty house with a catheter still in place, and an 85-year-old with dementia was sent home alone at 11pm without food, drink and bedding, and unable to get to the lavatory.
Michael Bird, from Nantwich, Cheshire, spent more than 30 years running care homes. But this was of limited help when it came to getting adequate treatment for his 86-year-old father-in-law Stanley Wyatt.
Stanley, a retired lathe operator with memory problems, lived alone in Crawley, West Sussex.
He regularly collapsed from heart rhythm abnormalities and was repeatedly in hospital in the final months before his death last November. He had difficulty walking or feeding himself and was incontinent.
‘It was obvious he needed to be kept in hospital so they could at least find out what was wrong with him, but they would just get him stable and send him home later,’ Michael said. ‘Often they wouldn’t let us know he had been discharged at night.’
Once the family complained about the practice, they would get phone calls from the hospital at 10pm, or even later, saying they were planning to discharge Stanley.
‘We would repeatedly tell them they couldn’t do that because it would take us four hours to get there. We often had to threaten them with a safeguarding alert, which means the hospital would be reported to the emergency services for needlessly putting a patient in danger.’
Nadra Ahmed, chairman of the National Care Association which represents care homes, says increasing numbers of hospital patients are also decanted back into care homes without warning at night.
‘It can happen at one or two in the morning because the hospital decides they need the bed,’ she says. ‘Medication is missing, notes are missing, there are no records of what treatment has been given or what future care is required.’
Bernard Jenkin, the MP who chaired the PACAC investigation, said the committee had even heard reports of ‘discharge teams’ scouring wards at night to select patients for removal.
He is outraged by the practice, which he believes has been going on unchallenged for many years but has become worse as a consequence of financial pressure in the NHS and social services. ‘Part of the problem is that people don’t complain enough,’ he says.
There may, of course, be valid reasons for discharging a patient at night. If a patient has been examined and seen not to need hospital care, they may prefer to go home.
Earlier this year the Government announced plans for a Discharge Programme Board, to improve integration between hospitals and social care providers. And in July 2015 the Health Secretary announced the establishment of a Healthcare Safety Investigation Branch, expected to investigate cases of unsafe discharge.
The Department of Health has said the Government would respond to Mr Jenkin’s report ‘in due course’.
‘Patients should only be discharged from hospital when it’s clinically appropriate and safe for them and their families,’ a spokesman said.
‘The best way to ensure that is to meaningfully integrate health and social care. We are investing billions to do so over the course of this Parliament.