The Battle of the Wards: How Outpatient and Inpatient Care Became a Tug of War (and Why We’re the Ones Getting Rope Burn)

By Antonia at Unremarkable Me

Where the System Ends and We Begin

I’ve always said that navigating chronic illness is like being forced to play a game you don’t understand, where the rules change halfway through, and no one tells you what the prize is—if there even is one.

But nothing quite prepared me for the Olympic-level nonsense that is the chasm between inpatient and outpatient care within the NHS. It’s a turf war. A never-ending, passive-aggressive custody battle where patients like me get pulled into the middle, expected to juggle our crumbling bodies, hospital politics, and appointment letters that read like cryptic prophecies.

And while both sides swear they have our best interests at heart, what it really feels like is a battle of “Not It.”

Over the course of my recent ten-day NHS misadventure, I experienced this tug of war firsthand. And let me tell you, the only thing worse than the pain, seizures, and utter chaos of my body shutting down was the chaos of the system itself, treating me like a hot potato no one wanted to catch.

This isn’t just my story. It’s the story of thousands of patients being left in the cold between departments too overwhelmed—and too siloed—to offer the kind of joined-up care we need. So, let’s break it down. Let’s talk about what happens when the two sides of care can’t play nicely—and why it’s always the patient who gets hurt.

Inpatient vs Outpatient: Same Goal, Wildly Different Game Plans

Inpatient Care

This is the sleepover-from-hell option. You’re admitted to a hospital bed, under constant supervision, with doctors, nurses, and enough machines to make you feel like a bionic burrito.

It’s intense, full-on, and often overwhelming. You get access to tests, treatments, and a round-the-clock medical team—but you also give up control of your own care, your body autonomy, and any sense of what day or night even is.

And trust me, it’s not as comforting as it sounds. During my recent stay, it felt like I was being passed from team to team like a hot potato nobody wanted to hold. Junior doctors—who I have nothing but respect for—were doing their absolute best, only to have their work undone when senior consultants floated back in after a long weekend like they owned the place and declared everything null and void. Decisions were made. Then unmade. Then made again, in reverse. Meanwhile, I’m lying there, my head splitting, my symptoms screaming, and my body collapsing from the inside out—while doctors squabbled over who should do what.

Outpatient Care

This is the DIY approach. You’re seen, treated, and sent home faster than you can say “Was that it?” You’re given instructions (sometimes printed, sometimes mumbled), and then you’re expected to manage the fallout at home, figure out your next steps, and know when to panic.

And if you miss something? That’s on you. I’ve lost count of the times I’ve sat in outpatient clinics where I felt more like an admin error than a human being. After my recent admission, I was discharged so quickly and with such vague instructions, it felt less like care and more like being kicked off the ride at closing time. No one called to follow up. No clear plan. And when things went wrong (spoiler: they did), I was left to fight tooth and nail just to get seen again.

The Tug of War: When Systems Clash, Patients Lose

This isn’t just a grumpy patient’s rant (although... fair).It’s backed by reports, inquiries, and investigations showing the same systemic failures across the NHS.

1. Health Services Safety Investigations Body (HSSIB), 2025 This report pulled no punches. It called out England’s health and care system for being so fragmented, it causes actual harm to patients—especially those with long-term conditions.Patients end up stuck in a web of confusing, overlapping services, repeating their stories like a broken record, and often burning out completely.Which, by the way, is exactly what happened to me.Source: The Guardian, April 2025

2. NHS Scotland’s Bed Blocker That Broke Records One patient in Fife stayed in a hospital bed for over seven years because there wasn’t a suitable care facility to send them to. Seven. Years. This is what happens when inpatient care can’t hand over the baton to outpatient services. Source: The Sun, May 2025

3. Essex Mental Health Deaths Inquiry (Lampard Inquiry) Thousands of deaths, many within months of discharge from mental health inpatient services, revealed a chilling gap in follow-up care. It’s one thing to discharge a patient. It’s another to make sure they don’t fall into a black hole afterward. Been there. Done that. Still waiting on the discharge call. Source: The Times, May 2025

What Does This Mean for People Like Us?

We end up:

• Playing care coordinator while exhausted, sick, and confused.

• Chasing discharge letters that feel like cryptic riddles.

• Being told we’re “not sick enough” for inpatient, but “too complex” for outpatient.

• Falling through cracks so wide you could drive a hospital bed through them.

I lived this last month. It’s like being on the worst rollercoaster of your life—but you’re the one who has to hold the safety bar in place.

How Do We Fix This Hot Mess?

1. Integrated Care Systems (ICS)These were meant to be the magic wand. A way to get all sides playing nicely together.Progress? Mixed. Promise? Still there.

2. Care Navigators (Actual Humans!)Imagine having someone whose literal job is to help you understand your care journey, coordinate appointments, and hold your hand through the admin swamp.They exist in some trusts. I haven’t met one yet. But when I do, they’re getting a hug.

3. Cross-Service Communication (Shocking Idea, I Know) Shared digital records. Joint meetings. Actual conversations between teams. Wild, right? But during my hospital stay, I saw just how badly we need it. Junior doctors trying to chase community notes on scraps of paper. Letters that never arrived. Patients caught in limbo.

Conclusion: The Rope Burn That Stays Long After Discharge

If my recent hospital saga taught me anything, it’s this: the NHS is full of incredible, caring, exhausted people. But the system they’re working in? It’s not built for people like me.

When outpatient and inpatient care treat each other like rival football teams, it’s not just an admin issue—it’s a patient safety issue. It’s an emotional wellbeing issue. It’s a human dignity issue.

We can’t keep expecting patients—especially those of us with complex, long-term conditions—to act as our own care coordinators, translators, and safety nets. We’re already holding together bodies that betray us daily. We shouldn’t have to hold together the system, too.

It’s time to stop the tug of war. Time for inpatient and outpatient services to stop treating each other like opposing armies and start working together like teammates—because we, the patients, are tired, hurting, and frankly out of hands to catch ourselves when we fall.

And if they need a reminder, I’ll happily send them a copy of this article. Printed on a hospital gown.

Support Links (Because Sometimes You Need More Than Sarcasm)

• Healthwatch England: How to raise concerns about care coordination

• Patient Advice and Liaison Service (PALS)

• Citizens Advice: NHS Complaints Process

An Open Letter from the Patient Stuck in the Middle

Dear Inpatient and Outpatient Care,

Hi. It’s me. The one you keep tossing back and forth like a game of medically fragile ping-pong. You know, the one with the inconvenient body that doesn’t quite fit either of your neat little boxes? Yeah. Hi.

I wanted to take a moment, from my position wedged awkwardly between your bureaucratic silos, to say...Please, for the love of all that is humane, could you both stop fighting long enough to remember I exist?

I get it.Inpatient, you think Outpatient has it easy. They send people home with a leaflet and a cheery “call us if you’re dying.” Outpatient, you think Inpatient is stuck in the dark ages, hoarding beds and over-medicalising everyone.

But here’s the thing: While you’re busy arguing over who does what, I’m sitting in the middle, holding my discharge paperwork, my next clinic appointment (that no one told me was canceled), and enough anxiety to fuel a small power station.

I’m the one having to explain, for the twelfth time, why I’m back in A&E. I’m the one chasing letters that never arrive. I’m the one juggling meds, follow-ups, symptom logs, and a body that doesn’t play by your neat referral pathways.

You see me as a patient for one hour.I live this 24 hours a day.

So let’s be clear:I don’t care who gets the funding.I don’t care whose rota is stretched thinner than my patience.I care that I’m not left standing alone, holding the wreckage of my care, while you two pass the blame baton like it's the Olympics.

I want you to talk to each other.I want you to share records, not hide them behind departmental walls.I want you to see me as a human being—not as an administrative inconvenience to be filed under “someone else’s problem.”

Because, honestly? I’m exhausted. And if I have to coordinate one more follow-up clinic myself, I’m going to charge you both consultancy fees.

Yours sincerely,

The Medically Complex Hot Potato You Keep Dropping( Antonia... since we’re clearly going to be seeing a lot of each other.)

Love Unremarkable Me