• National data shows almost a quarter of patients with spinal cord injury had their discharge delayed
  • In one case uncovered by HSJ, a patient was stranded in hospital for five months as officials argued over providing specialist equipment
  • Clinician says another patient in a spinal injury unit centre waited nine months in hospital for respiratory equipment

Patients with serious spinal injuries are unable to leave hospital for months because of “squabbles” between commissioners and providers over sourcing the equipment they need to go home, HSJ has learned.

Data shared with HSJ shows that almost a quarter of hospital patients in England with spinal cord injuries had their discharge delayed in 2016-17.

In one case detailed to HSJ, a patient was left in hospital for five months following a series of delays by commissioners and providers in acquiring the specialist equipment he needed to leave hospital.

A clinician working at a spinal centre told HSJ about another case where a patient waited nine months in hospital for respiratory equipment.

The clinician, who spoke on condition of anonymity, said: “Where somebody needs expensive, bespoke equipment it’s difficult to find out who is responsible for ordering that. It is a big deal.”

There are nine specialist spinal injury centres in England. In 2016-17, 23 per cent of patients at these centres had their discharge delayed, according to data from NHS England’s national SCI database, shared with HSJ. 

The cause of many delays is dispute between providers, and both NHS and local government commissioners, over who should fund equipment, HSJ was told.

Carolyn Jackson, a former intensive care nurse, told HSJ how her brother was left waiting in the Stoke Mandeville SCI centre run by Buckinghamshire Healthcare Trust for five months past his discharge date because “various authorities were fighting over who needed to pay for his equipment”.

Documents seen by HSJ show Ms Jackson’s brother was due to be discharged on 26 April 2017 but did not leave the centre until 3 October.

He was approved for continuing healthcare funding by North East London Commissioning Support Unit, on behalf of South Kent Coast Clinical Commissioning Group, but the CSU argued that Kent Community Healthcare Trust was responsible for sourcing a piece of specialist equipment he needed at home.

It took more than six months for him to receive all the equipment he needed. Other complications cited by Ms Jackson included her brother receiving an incorrect bed, hoist and shower chair, and a powered wheelchair with a faulty battery.

Ms Jackson said: “It’s been stressful, anxiety provoking and frustrating. The fragmentation of the system means there is no continuity of support for people coming out of hospital.

“Because there are so many different commissioners and providers involved, they just don’t see there is a person who requires support.”

A spokesman for the Spinal Injuries Association said: “It is unacceptable that SCI people are prevented from returning home from hospital whilst local providers squabble over the vital equipment they need to live an independent and fulfilling life.

“Delays in essential equipment provision are a significant cause of delayed discharge across the country.

“They cause blockages in the system, which keeps other newly injured people from accessing highly specialised SCI health services.”

An all party parliamentary inquiry into the issue in 2015 found the NHS had “a system paralysed by delays caused by the fragmentation of services [and] a system clogged with patients awaiting discharge from SCI centres but unable to leave due to delays in the provision of community services such as NHS continuing healthcare and equipment such as essential ventilators and wheelchairs”. The inquiry identified three main issues causing discharge delays from spinal injury centres: assessment for CHC funding; care package and care provision; and equipment provision.

A spokeswoman at NEL CSU said it would not discuss individual patient cases but said: “Our CHC team works on behalf of our CCG customers to assess and review patients’ eligibility for NHS continuing healthcare (in accordance with the Department of Health national framework for NHS continuing healthcare and NHS funded nursing care) and ensure that care to meet assessed needs can be delivered quickly.

“We follow strict procedures to ensure the safety of all patients requiring long term support. We work closely with our provider trust partners so they can deliver the care to patients.”

A spokeswoman for Kent Community Health added: “We always strive to provide the best possible care for all our patients.’’

South Kent Coast CCG and Buckinghamshire Healthcare Trust were approached for comment.

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