Human Rights in Mind When Discharge Planning

Human Rights in Health and Social Care

Human rights are fundamental to ensuring people receive dignified, respectful, and equitable care in health and social care settings. In the UK, various laws, frameworks, and initiatives guide health and social care providers to uphold these rights.

Health and social care providers must prioritise human rights in discharge planning, particularly in a complex discharge, where people need more specialised care after leaving the hospital. They must adhere to legal frameworks, involve people and their support networks, address complex care provisions, and ensure safe and coordinated care transitions. In doing so, they can fully respect and treat people appropriately and promote their dignity, autonomy, and well-being.

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Human Rights Act 1998

The Human Rights Act requires all public authorities, including health and social care providers, to treat people with respect, dignity, and fairness. This obligation extends to protecting people’s rights to life, security, liberty, and private and family life throughout the discharge planning.

Mental Capacity Act (MCA) 2005

The MCA offers a framework that encourages people to make their own decisions while ensuring that decisions made for people lacking capacity are in their best interests. It stresses the need to presume capacity only if proven otherwise and to take all practical measures to assist people in making decisions about the health and care services they receive.

Care Act 2014

The Care Act mandates that social care providers have a legal duty to prioritise individual well-being and ensure that care planning is centred around the person. This involves acknowledging each person’s unique lifestyle and aspirations while striving to find the least restrictive options that still meet their needs.

Key Human Rights to Consider During Discharge Planning

What critical human rights must health and social care professionals consider during discharge planning? How can NHS bodies and local authorities exercising health and adult social care functions ensure these rights are respected and upheld? Discharge planning is a critical juncture in care, where the transition from a hospital setting to a home or another care setting must be managed with utmost attention to the person’s rights and well-being.

Right to Informed Consent

What does it mean for a person to give informed consent, and why is it crucial during discharge planning? Informed consent is the process through which a person freely agrees to proceed with a specific treatment after being fully briefed on the potential risks, benefits, and alternatives. This process is essential for protecting them from being coerced into decisions that may not align with their best interests, preferences, or beliefs.

Health and social care providers must be well-versed in their jurisdictions’ legal obligations regarding informed consent. Obtaining informed consent helps protect providers from liability for known complications that arise without negligence. It goes beyond merely securing a signature. It involves a comprehensive discussion and a shared understanding between the provider and the person they serve.

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Right to Participate in Decision-Making

Involving people in healthcare decision-making is fundamentally linked to ethical principles that respect autonomy and the right to make one’s own choices. Empirical evidence supports the idea that increased involvement in healthcare decision-making enhances satisfaction with care, irrespective of the choices made or well-being outcomes. Shared decision-making using decision aids has consistently received the highest satisfaction ratings, demonstrating that people greatly appreciate being actively involved in their decisions and receiving ongoing support.

Denying people the opportunity to participate in decisions about their own care can be seen as a potential human rights violation, mainly when decisions are made without clear communication or valid consent. The Human Rights Council emphasises the importance of protecting and promoting the dignity and autonomy of every person, including their right to make informed choices regarding medical treatment. By having transparent dialogue and respecting patients’ voices, healthcare providers uphold ethical standards and align with broader human rights frameworks that prioritise autonomy and equitable care for all.

Right to Dignity and Respect

Upholding the right to dignity and respect during discharge planning creates positive health outcomes and satisfaction. Health and social care workers listen to and honour the person and family perspectives and choices, incorporating their knowledge, values, beliefs, and cultural backgrounds into care planning and delivery. This approach ensures people and their families are actively involved in safe discharge planning and care at home. For instance, NHS bodies and local authorities ensure that carers and family members are involved in discharge decisions, supporting people to make fully informed decisions where appropriate.

Financial support for discharge is planned on admission or before elective procedures, ensuring that people and their families are well-prepared for the transition. Personalised care and support plans are used or updated as part of early discharge planning, involving the person receiving care and relevant parties to ensure that any change in their needs can be met.

Multidisciplinary discharge teams and care transfer hubs, comprising professionals from various sectors, work alongside the discharged person and their carer or family to plan the discharge. This collaborative approach ensures that all aspects of the person’s needs are addressed, promoting a smooth transition from hospital to home.

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Right to Accessible and Appropriate Care

The right to dignity and respect naturally gravitates toward the right to receive accessible and appropriate care. Discharge planning involves a comprehensive approach that includes discharge coordination, discharge teaching, and preadmission education. This ensures that care recipients and their families access the proper care for their needs and feel supported throughout the discharge process.

Tailoring hospital discharge information to the person’s learning style, social determinants, and health literacy needs is essential for accessible care. Flexibility in the discharge process allows for adjustments to discharge services to meet personal needs, ensuring people feel safe and ready to go home.

Roles and Responsibilities of Healthcare Providers

In health and social care, healthcare providers’ roles and responsibilities extend far beyond clinical care. An essential aspect of their duties involves developing comprehensive discharge plans, collaborating with social workers and local services, and upholding key human rights. These elements ensure people transition smoothly from hospital to home or another care setting, promoting their overall well-being and satisfaction.

Developing Comprehensive Discharge Plans

The Health and Care Act 2022 changed the hospital discharge process, allowing local authorities and the NHS to implement different discharge plans more flexibly. One example is the ‘Discharge to Assess, Home First’ model. This model suggests that the best place for people to receive care is at home. It brings together different types of support and helps foster people’s independence. From April 2022, NHS bodies and local authorities are recommended to adopt discharge processes that best meet the needs of the local population.

Discharge planning should begin during the person’s hospital stay as early as possible. This proactive approach allows for thorough preparation and reduces the need to rush the finalisation of aftercare processes. Discharge plans are tailored to the person’s needs, considering their well-being, social determinants, and personal preferences. This personalised approach helps ensure people can successfully incorporate the aftercare plan into their daily lives.

Collaborating with Social Workers

Discharge planning must follow a holistic approach. Social workers ensure inclusiveness and address the emotional, psychological, and practical needs of people and their families. They collaborate with the local authority, resources, care providers, and community sector organisations to provide emotional support and create a safe network for people post-discharge. They help locate necessary resources such as home care, medical equipment, and community support, ensuring people have everything they need to continue their recovery.

Effective discharge planning led by social workers has been linked to lower readmission rates. By ensuring that people have the right support and resources, social workers help prevent complications that could lead to readmission, improving overall healthcare outcomes.

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What is an Unsafe Discharge From Hospital

An unsafe hospital discharge happens when a person is sent home without ensuring they are ready, adequately assessed, or provided with the necessary support and information for their ongoing support and care. Can you imagine the emotional trauma born out of this event? The fear and uncertainty can be overwhelming, leaving lasting emotional wounds that may take a long time to mend when people are left unsupported in such vulnerable moments.

Key factors contributing to unsafe discharges include:

• Premature Discharge: Releasing patients before they are medically stable can lead to adverse health outcomes and potential readmissions.

• Inadequate Assessment and Consultation: Failure to properly evaluate patients’ needs or involve them in discharge planning can result in insufficient care arrangements after discharge.

• Poor Communication with Relatives and Carers: Not informing family members or caregivers about the discharge can leave patients without essential support, increasing the risk of harm.

• Lack of Coordinated Care Plans: Discharging patients without a comprehensive home-care plan or due to poor coordination between health and social care services can compromise patient safety.

The new Mental Health Bill reflects an evolving understanding of mental health conditions, recognising the old legislation fails to address current needs. It mandates creating personalised care and treatment plans for people, detailing the measures needed to support their recovery and facilitate their discharge planning process.

Can You Refuse to be Discharged From Hospital?

While patients generally have the right to refuse discharge, this right is not absolute and can be complex in practice. People retain fundamental human rights, allowing them to challenge a discharge if considered unsafe and have the legal right to be involved in decisions about their discharge. Several pieces of legislation support this:

1. The Health and Care Act 2022 introduced new duties for NHS trusts and foundation trusts to involve patients and carers in discharge planning.

2. Section 74 of the Care Act 2014 mandates that relevant trusts must involve patients and their carers in discharge planning as soon as feasible.

Can a Hospital Force You to Stay?

In the UK, one’s ability to leave a hospital depends on one’s status as a patient and mental capacity. While hospitals cannot generally force people to stay against their will, exceptions exist, particularly concerning mental health conditions and situations where a person cannot make informed decisions. It’s crucial to understand one’s rights and, when in doubt, seek advice from healthcare professionals or legal advisors.

Informal Patients: If you receive treatment voluntarily (i.e., not under any section of the Mental Health Act), you are considered an informal patient. As such, you have the fundamental freedom to leave the hospital anytime. However, discussing this decision with your care team is advisable, as they can inform you of any potential risks associated with leaving. They may consider detaining you under the Mental Health Act if they believe your departure poses a significant risk to yourself or others.

Patients Detained Under the Mental Health Act: If you are detained under the Mental Health Act (commonly referred to as being “sectioned”), the hospital has the legal authority to prevent you from leaving. This is typical because health professionals believe that you need to be assessed or treated for a mental health condition and that your health or safety, or the safety of others, would be at risk if you were not detained.

Patients Lacking Mental Capacity: Under certain circumstances, hospitals can keep people who lack the mental capacity to make informed decisions about their care to ensure their safety. This is governed by the Deprivation of Liberty Safeguards (DoLS), which are part of the Mental Capacity Act 2005. DoLS ensure that any decision to deprive someone of their liberty is made following a thorough assessment and is in the person’s best interests.

Leaf Complex Care is an Advocate for Human Rights

Leaf Complex Care is a dedicated advocate for human rights, emphasising equality, diversity, and personalised care within community health services. The organisation provides tailored support services primarily for autistic people, people with a learning disability, and people who require complex care. Their commitment to destigmatising mental health challenges fosters social inclusion and empowers people to make informed decisions about their care. By prioritising human rights in local service planning, our humanised approaches ensure that people are treated with dignity and respect, enabling them to lead fulfilling and meaningful lives.

We also address the critical aspect of community mental health by offering crisis support services that facilitate smooth transitions for people returning home after unnecessary hospitalisation admissions. By equipping our support teams with regular training in best practices and safeguarding, they enhance the quality of our support services and promote continuous improvement.

Through their proactive advocacy and commitment to community health services, Leaf Complex Care effectively supports people and their families, ensuring their needs are carefully prioritised and met.

Learn how Ashanti leads a joyful life where her needs and preferences are met and witness the impact of respecting people’s fundamental rights.

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