Elderly and Waiting For Hospital Beds Hospital S3 E5 Our Stories

To free up beds, the NHS have advised Nottingham University hospitals to cancel all routine operations. Despite this, almost every bed in the trust is occupied and in A&E patients are lined up on trolleys waiting to be admitted. I have to bring you in so that the health care of the older people team can take a look at you. How long are we going to be here? So I don't know unfortunately. So his bed request, he's coming in under acute medicine and they have no beds currently. Let me have a little look how many we've got waiting. We've got three people ahead of him so he could be waiting a little while. It's literally one out, one in. Many of those waiting for beds are elderly. I think just as a look at today, we have patients who are 69, 70, 76, 80, 80, 81, 81, 83, 83, 88, 88, 89, 92, 94, 95. The majority of our patients now are elderly with a whole variety of different problems. Nearly half of patients admitted through A&E are over 75. Once they are in hospital, getting them out can be difficult. Mr Mitchell, I'm Professor Harwood. I'm the consultant. Yeah. How are you? I'm all right. I want to go home. You want to go home. Good. Yeah, I mean, I understand why it's not good. I mean, I'm not ill. No, you're not anymore, are you? You were. Oh yeah, that was, I think, four months ago. 93-year-old Ray lost a leg through a hardening of his arteries 14 years ago and was admitted recently after falling at home. One thing that's been worrying everybody is if you might fall over again. I've only fallen over three times. So it doesn't bother you too much? No. Ray has been well enough to leave hospital for ten weeks. His discharge has been delayed by concerns over whether his dementia will make it difficult for him to cope at home. One of the things we've been discussing is whether you're better at home or moving to a care home. What do you think of that? I don't want a care home. Don't want a care home. No. So even if it was difficult or risky at home, you'd still want to go home, would you? Yeah. I don't want to go on the care thing. No. What we've got to think about is what he wants, what he's said in the past that he would want, what his family think is best for him. There's a process to be gone through in making decisions about whether somebody gives up their own home or goes back home and takes the risks that might be inherent in going home. So the problem is that we need carers to come home with you to look after you when you're at home and there aren't very many of them about and we've been waiting for them to be available. Hiya, social workers. Ray's care at home will be arranged by Charlotte Majeed. Ray is needing support with most of his care needs, things like his eating and drinking, making sure his medication's taken at the right time. So Ray will be going home with four calls a day, so morning, lunch, tea time and bedtime. She is one of a team of social workers based at the hospital who arrange care packages for patients. Why has he spent such a long time in hospital? Mainly because we've been waiting for the package of care. It's longer now than it used to be, waiting for the care, because we just don't have as many carers. There's always the drive to try and recruit new carers, but I just don't think it's a job that a lot of people want, so that's then causing the delay for people in hospital. Sorry, Andy, I'm just multitasking. One sec. It could be days, it could be weeks, and the hospital environment's not the right place to wait for it. Ray will remain in hospital until his care package can be sorted. In a way, it's not worth living, is it, in a way? I forgot most of the things now. I wouldn't forget it. If you have a particular combination of needs, the system needs to be able to meet those needs. We can't put him in a wheelchair and leave him out on the Derby Road and saying, you don't need the hospital any more. That's neither humane nor responsible. It's not the patient's fault, it's the system's fault. The hospital is still full. Senior staff meet to discuss how many patients will need a package of care in order to leave, known as a supported discharge. Everyone's here? Shall we start? OK, morning, everybody. Currently, we've got 692 patients in our beds waiting supported discharge. How many? 692. 692? Yeah. And 220 of those have been medically safe for more than 24 hours. So that's the tidal wave that's now hitting us. I've never seen it that high. So that's going to be our problems this week. 692 patients needing supported discharge. So that's a discharge where another agency is involved, where they need some kind of care in the community, be it at home, be it in a different nursing facility. So that's a huge number. Of the 692 patients who will need supported discharge, 220 are well enough to leave today. Are you feeling increased pressure now? Yeah, we feel the pressure because we're the people who have to try and get people out in order to let people then in, I suppose. So we're always going to feel that pressure and we always have felt that pressure. At the end of the day, we do as much as we can as quick as we can. Almost half the adult patients in the hospital will need a care package in place before they can leave. So we're concerned that we're going to get completely gridlocked because we do need the frail and elderly patients to go out to the suitable facilities to start, I guess, throwing up some beds for us to move patients through the system and hospital. Every hospital department is under pressure from patients stuck in beds they no longer need. On the paediatric high dependency unit is four-month-old Spencer. He has been here since he was born with underdeveloped lungs. We didn't have a clue. We thought it was just going to be the perfect ending, have our son go home the same day, but didn't plan out that far. We had an early inducement. His heart rate dropped while he was inside. So then an emergency C-section was the only way to get him out safely. I didn't see Spencer for, what was it, seven hours? Seven hours. About seven hours. And then when we finally did see him, obviously we got told about his undeveloped lungs. It became clear really early on in his life that he required breathing support and a significant amount of breathing support. So he has a combination of being very, very weak in his core muscles and he has small lungs as well. We elected to do a tracheostomy, so a proportion of the breathing effort is done by the ventilator. Spencer would almost certainly have died if it weren't for the mechanical support that he's getting right now. There is a possibility he'd be on a mentation for life. It was touch and go from when he was born. They said, it's not looking great, he might... chance he's going to pass away. But he proved everyone wrong and now look at him. Although Spencer can't breathe independently, doctors have said that with the right support he can go home. The family live in a two-bedroom flat, but as Spencer will need 24-hour care, he can't share a bedroom with his sister. The biggest barrier is housing. Spencer's going to need his own bedroom or his own downstairs room where a carer can look after him overnight. It's like a mini intensive care, so they still have that level of care at home. OK then, guys. So we're going to just do some suctioning on Spencer's tracheostomy. Yep. It can be months and months and months. The houses have to be quite specific. It can be a bit challenging when we've got a child that's medically stable and the only thing that's stopping them going home is that they haven't got a suitable house. Hi, pretty boy. We're only 21 years old, and we've never had anything in our life like this happen, and it's just difficult. You do get really frustrated. You just want him to come home, but he can't. It's as simple as that. There's no other option about it. So he just can't come home. Come here. Not yet. Not yet. Queen's Medical Centre Resource, Ali speaking. Airways patent. Seaspine protection is on. In A&E, there has been no let-up in the number of new patients needing hospital beds. Without enough patients being discharged, the hospital is gridlocked. How many are going to be discharged today? We've not got many discharges at the minute. We're very much reliant on board rams. OK. At the moment, there's some babies, but only four definite discharges. OK. The Trust has already taken a series of emergency measures to increase capacity. Can we just have a clear list of what we've absolutely done internally? The beds we've opened, the rounds we're doing... The cancellations. The cancellations. So we're really clear. Many patients still face a long wait to leave hospital, while social services and other agencies arrange care for them. We've done every action internally. We're jam-locked, because what's going out isn't meeting what we need internally to go out. I agree with that. It's so frustrating when colleagues say, oh, you're in crisis, what do you want us to do? Well, how about your job? Just deal with it. You know what the list is. You know who the patients are. It isn't a mystery. Why are you asking us to tell you what your job is? Your job is to create capacity for outflow. It's hard for us to know what more we can do in our control to deal with that. If the hospital can't discharge enough patients, the only option left will be to free up beds by cancelling cancer surgery. Are we making a decision on cancer patients tomorrow at 1 o'clock? Cancer patients? I'm really reluctant... I want to know what Jo's plans are, cos I'm very, very anti-cancelling. I'm reluctant to cancel any cancer or any urgent... ..to get into this campus. So I think we do need... Let's have a chat. But isn't that... Haven't we got to have that on the agenda with the partners, to say this is our only option now? We're going to cancel cancers. After New Year, we had options of bringing down elective operations, which we've done. Today, we've got nowhere to go. It's dreadful cancelling routine operations, but it's even more dreadful cancelling patients who've got cancer. Cos that really is life or death. For me now, it's about what our partners can do to help us. Just quickly, it is very, very desperate. We're not going to do a dial-in. We're going to have them around the table, cos you get a better outcome. We've got Alan and Simon Parsons coming to describe what it's like, cos there's nothing more internal we can do. I mean, tomorrow, absolutely tomorrow, there is no way I want to cancel cancer. I just feel completely strongly, ethically, that it's so, so, so is the wrong thing to do for our patients. It's starting to feel like crying now, thinking about it. Every one of Nottingham's health and social care providers is called to a crisis meeting in the hospital. One of those attending is Director of Nottingham City Council's Adult Social Services, Helen Jones. If somebody was to say social services aren't doing their jobs properly... I'd say we're really doing our jobs properly, based on the resources that we've got to do our jobs with. And if you're blamed for the fact that there are so many people stuck in A&E, what would you say? I'd say we've got to look at the bigger picture here, and the bigger picture here is that there are solutions, but those solutions cost money, and some local authorities haven't got the money that we need to put those solutions in place. Going back three years ago, we didn't have any difficulties in terms of moving people out of hospital. It was really straightforward. I mean, this bit of what we do and what I'm responsible for is the easiest bit. It really should be. Somebody in hospital needs to go home, they need home care. It's so straightforward to organise, but fundamentally the issue here is that we haven't got the resources that we need. You know, I feel personally what's difficult is that we can't help out in the way that we used to be able to. This lift is out of service. Hello? Yeah, I'm so sorry to bother you, but it's rather urgent. It's Caroline and I've got to go to a meeting at four o'clock and I've got a load of people waiting. Tomorrow's cancer surgery depends on whether Caroline and the health and social care providers can clear the backlog of patients waiting to leave the hospital. One of those desperate to go home is 93-year-old Ray. You was in the Navy, weren't you? The Navy? Yeah. I think so. I think so. Six years. Do you remember when you was in? Six years. You was in for six years? Yeah. I was a torpedo man. He goes on about his Navy days and he starts talking about my mum because we lost my mum eight years ago. But normally he's just quiet. He's like, you know, for now. He just wants to go home. Ray can't leave hospital until carers are found to help him at home. It's a joke, isn't it? All these people just sitting there waiting to go home and they can't because there's no carers or funding available. Not this week, no. So I've not heard anything. Dad, we ask every day. We're on the phone all the time. You know, Dad's worked all his life and then it comes to this, that there's no carers to look after him. So what's, you know, all his taxes and National Insurance, what's it all for? Because he's not getting any benefit out of it. It's disgusting. He's been here, what, for 12 weeks now and he should have only been here for three weeks. They're queuing to get in and he's queuing to get out. There's no need for him to be here. If we didn't work, we'd take him home and look after him ourselves, but we can't do it. We just don't have the capacity or the time to do it. It sounds awful, it might make us sound bad, but, you know, we've all got mortgages to pay. You know, we've just got to rely on social services and they're just not. I don't know. We should get the flipping finger out. Many of the 220 patients who are well enough to leave are four miles across town at the Trust's other hospital, Nottingham City. Hello, Jean. Where are you going? I just want to check your blood pressure. Oh, yes, perfect. And also to see how you're breathing. And also... Only just. Only just, yeah. After being treated for pneumonia, Jean has been well enough to leave for two weeks. She too is waiting for a package of care at home. When did you come to the hospital? The day before Christmas time. Is it? I've been here all this time. A doctor saw me yesterday and she said, would you like to go home? I said, yes, I would. I've got such a lot to do. And then they brought me down here, so I thought, might as well put pages up then. I don't know how long I'll still be down here, I'm sure. I mean, these pages are all right when you're really, really ill, but I don't feel ill now, so I think I could go home and cope. I want to go on the outside world again. Jean usually lives on her own and she needs social services input. And the social worker that I've been talking to has informed me that her house is very cluttered and at the moment she would not be able to get any carers in with all the clutter that's in the property. We couldn't send her back into that environment. It's just not acceptable. I've been on my own 17 years since my husband died. So I've always been independent and I've always looked after myself, paid my bills and, you know, not relied on anybody. I managed to do it myself and that's what I want to do again. It's just that when you live on your own, you do get cluttered up a little bit and that's what's happened to me. Hello, Jean. So I've been speaking with your granddaughter and she's going to get your house decluttered, OK? Yes. Try and get it cleared so we can get the carers to come in and care for you. Oh, I see, yes. Once both of those things are done, we'll get you home. I can't give up. No, definitely not. We're nearly there. I mean... We'll get you home, OK? Right, thank you. All right, thank you. Thank you very much. Bye. I don't want them to interfere too much. Well, you only live one life, don't you? If you don't live it how you want, you can't do much about it because you can't do anything about it when it's gone. At Queen's Medical Centre, after four hours of negotiations, Caroline emerges from the crisis meeting with Nottingham's health and social care providers. I was hugely worried this morning. I really struggle to counsel cancer patients. So I'm pleased tonight. We've made progress. We are planning to purchase around 120 beds. To avoid cancelling cancer operations, the NHS regional funding body has agreed to pay for extra beds in private care homes at a cost of half a million pounds. Hopefully that will help us discharge more of our complicated and supported patients to get flow. Does it feel like a positive result for you to get these extra beds? It's a good result, but I kind of think we shouldn't have got to this point. A difficult meeting in many ways in terms of some significant work that's had to be done in the last four hours. Positive in that it solves the immediate problem in the hospital. Positive in the sense that it means the hospital isn't going to have to cancel cancer surgery. The risk is, as we go in tomorrow, that some of the people that are waiting for home care will also have to move into residential beds. To clear the backlog of patients quickly, many of those who need care at home will now be moved out of hospital into residential care homes. We've done it before, I should add, and we've got learning from that. Part of the learning is don't do it again. We know that 78% of people that go into short-term residential care end up in long-term residential care, so they don't come home because it's disabling, because it's not the right place. All the reasons we know it's not a good thing to do, but neither is having people waiting on trolleys in the ED. OK, so for the three who are medically stable at the top, you said you couldn't estimate a discharge date that they're medically stable. Is that just getting them their social situation set up so that they're safe to go home? Is it just that package? There's no imminent discharge date for any of these patients. Housing is just a big issue. These patients don't have houses to go to. I think that we really need people to appreciate and buy into the fact that we've got children in a critical care environment who really don't need to be and really need to be at home. Four-month-old Spencer cannot go home until suitable housing is found. He needs to have the ventilation support and the care package that he needs to support him at home, but he also needs a home environment that will support him to be cared for. So he needs a bedroom of his own because he'll have overnight awake carers and the rest of the family need to obviously go to bed at night. We do get angry knowing that the house is the thing stopping us, that he could be home with us if we had a house. It could take five months, could take a year, until we get a house, we just don't know. Until he can leave hospital, Spencer will remain on the high-dependency unit at a cost of around £1,000 a day. So thank you for those who've made this meeting. My name's Adele Frost and my job is trying to get Spencer home. So we did a housing assessment when you were down on neonatal unit and your current property is not going to be suitable for discharge, is it? So we know that Spencer's going to need his own room and she's going to have carers in there looking after him as well. So all those letters have been done and you're on the top bracket and I know you're chasing housing department on it. Yeah, we rang them but we weren't really satisfied. So we went in. I just said that there's no top and bottom in the group. You only get to band one if it's medical reason. Obviously we're in there for urgent medical reasons but there's just no houses. Finding houses anywhere in Lincolnshire, Derbyshire or Nottingham, which is quite difficult at the moment, and there are more and more children on the unit that are requiring long-term ventilation. So at any one time I've normally got two or three children on critical care. At present I've got nine children throughout the region that I'm trying to get home. So it's very demanding on our services. So we've got to start sorting everything out in your flat for you. Sort everything out in your flat now so you can come home. Jean's home has been deemed unsafe by social services. Granddaughter Dana must declutter it before she can be discharged. Grandma doesn't have a very large family. She's really only got myself and my partner and my grandson since my mum passed away. I worry about her all the time. If you can tell me which sort of things you want removing first of all and I'm going to make a start tomorrow. It makes me feel guilty that I haven't seen her since she's been in hospital quite as much. I'm in a situation where I am trying to look after my son at home and now I've got my grandma here that really needs my help. But I'm on such limited time that I can't devote all the time that I need to look after her. So today, today, I'm going to take your key. Yeah, I thought you had a key. No, I've not got a spare key. No, it could be in your belongings somewhere. I'll find it. They were put into a brown envelope to keep them together. You see when you've got that one key, so it'll need another lock, another key made. The key has gone missing. So we can't get Grandma home now. She's the only one with a key, full stop. Has anyone else got a key? Nobody. You can't get a private locksmith to come and change the lock. You're not allowed with the warden. I think it's testimony to the problems in the hospital at the moment. She's been moved from various wards because they've needed the bags for different cases. And I've understood the reasons for her moving from ward to ward, but I think these are vital pieces of personal belongings. It's not just a little book she's lost or something. It's her home keys. I've been moved around so much, I really ought to put everything together in a bag. The problem is without that key, we can't get in your flat anyway. The keys are not on Winnie 2. They said that they were on the ward and they've looked everywhere and there's nothing up there. Let's hope for the best. That's all we can do, isn't it? This lost key is the major issue. I just wish we could find that key. I've got to come to some arrangement sometime. I'm just seizing up in here. I have trouble. It's been here just a long while. Not moving very much. It's not on. Jean is going to take some time because we can't organise the package of care because of all the issues with the property. So rather than her in an acute medical bed at the cost that it costs a medical bed a night, have her in the community and have the community deal with it so she's not in an acute bed. I've just spoken to Bev Brady and said that I could arrange with the social worker for yourself to get a spot purchase bed in the community for Jean Smith. The next day, with the key still lost, arrangements are made to move Jean to one of the newly purchased beds in a residential care home. Where's Jean going to go? So this is what the social worker is finding out, whichever placement she can go to, then we will arrange for her to be transferred to that community bed. She will stay there until everything is sorted out about the property being decluttered and about the carers starting. And her key as well? And her key, yeah. That's got to come to light at some point. Hello Jean! Are you alright my darling? How would you feel if we got you out of hospital and put you in a nursing home temporarily until we get your house sorted and the carers arranged? Well, I think I'll be better then because I know what I can do for me here. No, you're not having any medical treatment now are you? I'm just sitting here waiting, aren't I? Waiting. Taking somebody else's seat. Aw, bless you. Another patient well enough to leave hospital is Ray. Last I heard we were waiting for a QDS package of care, so four times a day package of care double up, which he's now been waiting for since the 4th of December because I know that his family are getting to the point now where they've quite fed up of us. What's my service area? After an 11 week delay, Charlotte has finally managed to arrange a package of care for Ray at home. Placement review team now? Oh my gosh, this is sad. I'm apprehensive about him going home. I'm worried that he's potentially at risk of coming quite quickly back into hospital but I'm also, I want to do what he wants to do and sometimes we have to do that even knowing that the risks are quite high because it's his life and if we can support him at home, we always want people to go home so we support him to do that. Right, Ray, I've got a bit of an update for you. I've got a bit of an update about getting out of hospital. We've hopefully found a care agency that can pick up the care package to get you home again so he'll be able to arrange a discharge out of hospital. Alright. It looks like you're going home. He's fragile, he's vulnerable. Being at home by yourself is not an easy option. Being in a care home is not an easy option. Care homes are for very disabled and damaged people. There's a balancing act. There are certainly risks but we know what the risks are and in conversation with him and with family, it is decided that we will take those risks. It's possible that he falls over and he breaks something. It might be catastrophic but that's a balance that you have to take because otherwise everybody would be strapped in an armchair wrapped in cotton wool. The chances of this working at home are no better than 50-50. Hi. Hi. Are you a big boy? It's dry time. Spencer has been well enough to leave hospital for over a month. Due to a shortage of suitable council housing, his parents continue to care for him in the hospital's high dependency unit. We've always wanted to be a family of four. The final day we get him home, we can just shut the door and sit there with four of us in one house. It will feel like we've made it then. A potential property for Spencer has become available. Occupational therapist Kate Hussain will assess its suitability. 28 on the door width. All they want is to be home as a family unit, being able to get on with normal life. For these children, because of their complex needs, it's finding a house that meets those complex needs. Because it's not just finding a house. It's a quite narrow door, isn't it? Yeah. 28 and a half-ish. Because of his ventilation needs, he needs an overnight awake carer. So because of that, we need a room where he can be cared for overnight without disturbing the rest of the family. There wouldn't be enough space in here for him and access around the cot. Yeah, I was going to say, three-floor lifts obviously are quite big. And you're going to struggle to get a three-floor lift and him in this room? Yeah. 28 and a half-ish. 327. It's very difficult to predict how long a family might be waiting for a property. We do have several of our families who've been on the waiting list for quite a long time, but because they have very particular housing requirements, the available stock that we've got, you can probably discount quite a lot of those already. How long is quite a long time for a family to wait? I have had a family who've waited several years. From a cot point of view in here, but I think you probably have to have it coming out into the middle because of both sides' access for emergency tracker change and stuff. It's very difficult when we don't know the prognosis. It is, isn't it? There is a limited supply of houses, and obviously our hands are tied, and so are housings as well, to a certain extent, because they can't offer a property they don't have. So it's all about working as a team, really. We've all got the same end goal, is to have this child at home. He's got his hat on, that's wicked. Yeah, I love it. While they wait for news on the council house, Spencer's parents are taking him outside for the first time. Are you ready for exploring the outside world? Let's check we've got everything then. This is a big step for him because he's four and a half months old and this is the first time he's left an intensive care environment. So this is one of the best bits of the job, when you reach this point where he can escape. Go on then. Hi. So at the moment he's going out with a nurse and a parent. When you're fully trained in absolutely everything, then he can go out with just you two. Right, are you ready to break free then? You have got to come back though, unfortunately. Like I say, it's not as easy when you've got all this equipment in the pushchair. Makes it heavy. From about 10 grams worth of equipment on the side. Most expensive pushchair ever. How was that? Amazing. It really was. The first time after four and a half months of being bed bound in a hospital. Amazing, just to get fresh air. A breath of fresh air really did mean that much today. It's so nice, but sad at the same time. Knowing you've got to take him back in the hospital. I know. You don't think of how much a walk down a path you appreciate. It's been two days since the NHS bought extra beds in residential care homes. The Trust is finally able to discharge some of the patients who have been unable to leave hospital. So we're currently on 82.6%. Yesterday's reports came out to 80.6%, so we did just get over 80. 240 patients through the department and we currently have 69 in ED. And we're going into the evening with a bed prediction that I haven't seen for a long time of minus 23. So that's healthy. So that's a really good start to the weekend. So we absolutely need to make sure we've got clarity over plans. Because there's been a lot of action today with our community and social care colleagues. Do you want to just give a brief update, Jen? Yes, we've worked since about 11ish this morning and we've only just finished about half an hour ago. To try and fill the next set of either community beds or at home capacity. There's commitment from the community to keep going. So on Monday we will meet again and we'll start on the next group. There's about 30 beds still out there that we know about. And they'll all be beds that we're using for the first time. So actually a lot of them we're trying over the weekend. All of our community partners, health and social care, have worked really hard. So I don't want anyone saying, no this patient's not moving. I don't want anyone saying, I'm not accepting this patient. Is that understood? That is quite a big progress really. It should enable us to discharge the patients who've been delayed with their discharges. And it should restore some flow in the hospital. So fingers crossed. I don't want to go into a residential home if I've been in hospital. Why do we assume that anybody else would? All you're thinking was, I've been in hospital, I've been ill. Good, everything's getting better, I'm going home. And then to find that you might be a couple of weeks somewhere else. It's just not the right thing. Someone is in a hospital bed and they get given a place in a nursing home. What's the problem with that? The difficulty is in a residential home, what you're being provided with is care, not rehabilitation. So people are looking after you, but they're not helping you to get back on your feet, to get back into doing the things that you were normally doing. Hello. Just trying to get up to social care, thank you very much. I don't feel good about it. It's not the service we should be offering, it's not the service we used to be able to offer. You know, it's not even the right service. People aren't even getting what they should be getting, which is being able to go home. A lot of citizens are worried, they're just petrified that they're going to end up stuck in a care home. And you can give them as much reassurance, which we do, but it doesn't, understandably, doesn't make any difference because they're worried about it. With the crisis that we've had, people have had to just purchase beds very quickly. We know that they're good quality homes, we know people will be getting good quality care, but what they won't be getting is that reablement or rehabilitative element that they need. So basically the risk is people go into residential care homes unnecessarily and then they don't come out. I've had people go into homes who then, we have to then do another review because their needs have deteriorated or they need more support. It's that terrible dilemma, isn't it, for the system? Because on the one hand, we've got all these pressures in ED and people on trolleys, and that's terrible. And on the other hand, you know, we have to get people out, but getting people out is sometimes doing quite terrible things to them and their family as well. So it's almost like we solve the problem here, but we create another problem at the other end, which is the end that social care deals with, and that's a huge issue. So the danger is people go into residential homes and then the environment that they're in means that they don't regain their confidence about living their ordinary life, and the danger is then they and their family collectively, or sometimes it's their family, because they're not in a position to kind of make those decisions, decides that they will stay in that residential home permanently. One of those who should have gone home but will instead go to a newly purchased residential care bed is Jean. Whatever happens, I've got to, you know, do my best to keep Becca up, as they say. You know she hasn't got any clothes? She's literally got what she stood up in. 90 dresses, whatever you've got, just a few bits and bobs together, and what I'll do is I'll get them collected. Fantastic, you are wonderful. The lady's name is Jean Smith. Just put her name on them, I'll get someone to come and I'll see what I can do about sorting it out. Thank you very much, appreciate it. Cheers, bye. Right. Fantastic. She looks good, don't you? Yeah. With a card, yeah. How do you feel? Do you feel more comfier? Oh, yeah. Oh, you look it. Hello, Jean. She's not going to home, but the next best place. I feel accomplished to get Jean out, yes, and get her in a nice, safe environment, so I feel accomplished, good teamwork, and we've done it. Hello, Ray. I got your lunch. It's your favourite fish and chips, yeah? Less than 48 hours after Ray went home, he's back in hospital after his carers found him unconscious and called an ambulance. The reaction to Ray coming back was disappointment. Obviously, you want your discharges to work. It was what he wanted, it was what his family wanted, but it wasn't to be. Mr Mitchell? Hello. I'm Professor Harwood, I'm the consultant. His family reported that he was drowsy and that he wasn't coping. So I think it was basically that his combination of dementia and physical disabilities was just too much for him. Because you were in hospital, you went home, you came straight back in hospital, and we've got to think what to do next. Readmissions are very, very common. It's about 20% in a month, it's about 40% in three months for the sorts of patients that we have on this ward. It's not done and dusted with a discharge. People are going to be back. Can you remember you went home? So I think what he's done is he's proved that he does need a 24-hour level of care, and the only way you can really get that is in a care home. The dementia's been about the last three years to seem to deteriorate. It's like sitting with a shell. He looks like my dad, but he's not my dad. It's nice when he's lucid and he doesn't know us, because then he'll start talking about my mum. He said he won't cry. It's sort of gone past his stage. He's gone back as if he's a child now, not a 93-year-old man. He can't. He can't go home. Are you all right? How are you feeling? I wasn't home for 20 minutes. I don't know to this day what happened. He's struggled to get into the house. He's struggled with the toilet. He's not been home 24 hours, and then he's back in. He doesn't want to go into a home, but if he's not safe, I'd prefer him to go into one. On the paediatric high dependency unit, occupational therapist Kate has news about the new council house. Hi. How are you? I'm good. As you know, we've been out to have a look, and it is good news from my point of view as the OT. I'm happy. Good news. I'm so excited. I know. Oh, God, I've been waiting all day. I'm like, come on. It's got a room downstairs that we can do some tweaking to make into Spencer's bedroom. We've got a home. This is the biggest thing that, yeah, it'll take weeks still, but I know we've got somewhere to take him home now. That's going to be our home. Oh, my God. I can't tell you. I've got pictures I can show you. They're not the best, but... As long as it's ours, that's good news. Is that good enough for you? Yeah, that's fine. Round floor toilet? He's like, what's going on? Why are you so excited, Mum? Here we are. So happy. It's just the goal now. We can get ready to go home, do you know what I mean? We can wait for the house and then get him decorated, get his room ready, plan everything. Six months we've been in hospital, haven't you? But that's it. Light's at the end. Tomorrow we can finally go home. Once the house is all sorted. Now I'm happy. So happy. It's a good part of the job, being able to make a difference and really made someone's day, really, cos they've now got a home to go home to. So, yeah, fantastic. How has it been in total, this whole journey for you guys? Awful. Awful. Worst time of your life, but it's moments like these where it gives you strength and you can keep cracking on. One good day's enough to keep you going for another month. And you're worth it. Yes, you are. It's our forever home, so... And it will be you. Hiya. You all right? I'm joining you today. Three months after Ray first came into hospital, he and his family are waiting for news about a place in a care home. Waiting to see on the decision whether they'll take my dad. The meeting was at half eleven, over an hour ago, so... I've been fretting. We've had enough in here, haven't we, Dad? He thinks he's going into a rehabilitation unit, but he's not, he's going into a care home. He's always said he'll never go into a care home, so we've had to lie to him and tell him he's going into a rehabilitation unit. It upsets all of us. We've found a lovely one. I'm just waiting for the phone call, but we can't do anything yet until they make that decision whether they're going to take him or not. And I don't know what we're going to do if they don't. Because we've set our hearts on that place. Hiya. Hiya, you all right? Yeah, you. What's happening? A quick update for you. Go on, please say yes. From the Kingfisher, who accepted him. Oh, God. So what we'll do now is just get the process moving. Oh, brilliant. I am... Get him over there. I cried my eyes out last night. I can't sleep now. No-one's crying now. I'm just so pleased. There will be some community follow-up now. I will be following up whilst he's there. Oh, I'm just so relieved. Oh. He should be going in a day or two. It's been confirmed. Yeah. It's good, isn't it? It's just been four months of emotional rollercoaster and I just want him settled and know he's safe. It's just amazing news. I'm over the moon. If you were looking at this as a business, you'd be investing in social care. What social care does is saves money to the NHS. If we can help people live their lives in the community, then, you know, that's so much cheaper for society, that's so much cheaper for the taxpayer. Hello. I'm really sorry, I'm still at the hospital. It's been the toughest year yet for us. Do you know, I think for the first time in my career, it's hard to see what the future looks like because the financial pressures are so enormous, really. People talk about the tipping point and I think in some local authorities, social care departments were there. And the danger is that this is just being accepted as the norm and that's the bit that frightens me when you ask me about, you know, what's it going to look like a year ahead? My fear is it'll look exactly the same, a little bit worse, and we will have accepted that. That's what happens to our most vulnerable people. It's so not acceptable. It's so not acceptable.