The patients whose lives are put at risk by hospitals sending them home too soon Special investigation by Jane Feinmann finds worrying new trend Patients are being sent home too early, while they are still unwell As a result, there has been a dramatic rise in 'emergency readmissions' Defined as unplanned admission within 30 days of discharge from hospital By Jane Feinmann for the Daily Mail Sharon Mounter felt a wave of rising panic when the nurse told her that she was being discharged from hospital. The 35-year-old events organiser from South London still had a fever, and felt so weak and dizzy she could barely sit up in bed. But the nurse insisted in a kind but firm manner that she was well enough to leave, adding: 'We need your bed.' Sharon had been in hospital for almost a week after being admitted with a high temperature and 'unbearable' joint pain. Doctors attributed it to a flare-up of her lupus, an autoimmune disease that causes the immune system to attack its own tissues and triggers fatigue, pain and skin rashes. Patients are being sent home too early, while they are still unwell, placing them at risk By the end of the week, she was still far from well. Yet a consultant who had been treating her echoed what she'd been told by the nurse - that she could now be safely sent home. 'I assumed the doctor had my best interests at heart - and it didn't occur to me to question what he was saying.' Yet back at home, under the care of her parents, Sharon became increasingly ill. Four days after she was discharged from hospital they took her back to A&E. After a series of blood tests, she was sent home again. The next morning, however, she received a call saying she had tested positive for septicaemia, a potentially fatal blood infection, and needed to return immediately. Doctors thought the infection might have been triggered by a bout of food poisoning Sharon had suffered the previous week. Although this wouldn't normally lead to septicaemia, the medication for her lupus lowered her immune defences, making her more prone to infections. Sharon spent the next seven days in hospital - including four days on an isolation ward - while she received intravenous antibiotics. Last year, there were more than a million emergency readmissions in England alone Her experience is part of a worrying new trend of patients being sent home too early, while they are still unwell, placing them at risk. As a result, there has been a dramatic rise in 'emergency readmissions' - defined as an unplanned admission within 30 days of discharge from the same hospital. Last week the parliamentary and health service ombudsman, Dame Julie Mellor, after reviewing cases referred to the organisation, said: 'We are increasingly concerned about patients being discharged unsafely from hospital,' adding that some such decisions may have been partly due to 'cost implications'. The problem is widely recognised. 'Too many people today are needlessly entering the revolving door of their local A&E again and again because somewhere in the system their care has broken down,' Care Minister Norman Lamb said recently. Last year, there were more than a million emergency readmissions in England alone - a 27 per cent increase on the previous year, according to figures from the Health and Social Care Information Centre. I assumed the doctor had my best interests at heart - and it didn't occur to me to question what he was saying One leading clinician, insisting on anonymity, told Good Health that hospitals today 'are rammed full - with ambulances being turned away - largely because of the high rate of emergency readmissions of people with chronic relapsing long-term conditions'. The elderly are particularly at risk. Approximately 150,000 people over 65 each year are readmitted to hospital within 30 days of being discharged, according to the charity Age UK. And in 2012, 6,100 patients who had suffered hip fractures had to be readmitted to hospital within four weeks. Meanwhile, the number of women who needed emergency readmission following a hysterectomy rose by 27 per cent last year. People with a chronic condition are also more likely to be sent home too soon - every year 37,000 people with diabetes alone are readmitted to hospital within 30 days. Kay Boycott, chief executive of charity Asthma UK, adds: 'At least one in ten people who die from an asthma attack have had hospital treatment within the previous month. And the majority will have had completely inadequate discharge and follow-up arrangements. It is a scenario Louise Degenhart recognises. The 32-year-old has severe asthma and suffered a life-threatening attack in April this year. By the time she arrived at her local A&E, she was struggling to breathe and her lips were turning blue. Louise was given nebulisers, which create a mist of medicine breathed in through a mask, as well as oxygen and intravenous steroids. Discharging patients too early to save money is 'often a background to clinical negligence cases' 'I stayed overnight and was told I could go home the next morning,' recalls Louise, a volunteer who lives in South-East London with her father. 'But I told the doctors I wasn't well enough to leave yet. I still needed to be on nebulisers every four hours and my oxygen levels were still dropping too low. I have a personal asthma action plan, which is tailored for me when I have an attack and is written by my specialist. It states I cannot be discharged from hospital if I need nebulisers more than twice every 24 hours and if my oxygen levels are not consistently high. Louise gave the doctors a copy of this plan. 'But they said I could go home because my breathing was settling down, my oxygen levels had improved and I had nebulisers at home - although these contained less powerful medications to the ones I used in hospital,' she adds. 'I felt I was being sent home to free up a bed because it was busy, even though I wasn't ready to go.' Within hours of being discharged, she had another attack and returned to hospital. She was immediately put on oxygen and given the stronger nebulisers again. 'I was admitted to a ward for four days before being sent home, by which time I felt well enough to go,' she says. Lack of beds is a major factor in discharge decisions. The overall number of beds in the NHS has been cut by 30 per cent over the past 20 years. Partly this is due to the trend of treating patients in the community rather than in hospital. Of course, for some people receiving care at home can be the best option. But as Peter Walsh, chief executive of the charity Action Against Medical Accidents, says, the combination of fewer beds and shrinking budgets is 'a dangerous cocktail that is leading to doctors making decisions that are inappropriate and unsafe'. Not surprisingly, discharging patients too early to save money is 'often a background to clinical negligence cases', says Luke Daniels, a solicitor with law firm Irwin Mitchell. The decision is usually the responsibility of junior doctors, says Dr Ben Molyneux, former chair of the British Medical Association's junior doctor committee and now a GP trainer. Yet he warns that this has become a box-ticking exercise, leaving patients returning home without a clear plan for their follow-on care. 'Too often junior doctors regard it as a bureaucratic process and that's got to change,' he says. They need to be well equipped to understand local services and the importance of clear communication with patients. I felt I was being sent home to free up a bed because it was busy, even though I wasn't ready to go This leads to the second key problem. Emergency readmissions are often due to a lack of intervening care at home, according to Katherine Murphy, chief executive of the Patients' Association. She says families must be more included by health professionals in what the patient needs once they have been discharged. Jules Acton, of National Voices, a charity that represents patients and carers, adds: 'There are impossible obstacles facing people who need follow-up care when they leave hospital - not least because of often almost total fragmentation between GP surgeries and hospitals and between health and social services.' 'For instance, it beggars belief that there is still no way that doctors in hospitals and in general practice can share access to patients' notes.' One success story is the Royal Volunteer Service's (RVS) Home from Hospital scheme. Over a year, it has halved emergency readmissions to three Leicestershire hospitals. RVS volunteers are assigned to patients who are about to be discharged - meeting them on the ward 'to make sure that the patients go home at a time that suits them as well as the hospital', says David McCullough, the charity's chief executive. The volunteer can drive them home, switch on the heating, turn on the lights and even provide a picnic pack to keep them going. It takes the panic out of the process. In the meantime, Sharon Mounter now listens to what her body tells her. For months I was so angry to think that my life could be put at risk just so I could be discharged at a time to suit the hospital. If only they'd listened to what I was telling them.'