Barriers that delay children and young people who are dependent on mechanical ventilators from being discharged from hospital.

A qualitative study of user perspectives published previously by the author found that children and young people who are dependent on ventilators spend many months and in some cases years in hospital when they no longer had a medical need or wanted to be there. This second paper is drawn from the same qualitative study and reports on the barriers that the children and young people who are dependent on ventilators, and their parents, described as important factors in preventing their discharge from hospital. Six issues were identified as significant barriers that prevented the children and young people from being discharged. These were: the attitudes of professionals; the lack of joint commissioning and accounting responsibility; general poor management both within the health service and in collaborating with other services; complex social issues; housing problems; and a general lack of auditing and outcome measures. The generalizability of the findings is unknown. However, recommendations are made in relation to the need to establish joint commissioning and accounting responsibility for care and services, and to establish outcome measures to monitor the effectiveness and appropriateness of the care and services provided.