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Show me the way to go home

On 9 June Philip Provenzano and Melanie Henwood facilitated a workshop for 25 Academic Partners exploring findings from a range of recent IPC work on Discharge to Assess (D2A). As we have described in our recent Briefing Paper D2A has been the subject of focused policy attention throughout the pandemic, driven initially by the imperative to release hospital capacity. However, the objectives of ‘Home First’ and ensuring that people are discharged to the right care, in the right place at the right time, have gained currency over a longer period. Indeed, the challenges of timely discharge of people from hospital have attracted recurrent concern over decades, epitomising the difficulties of delivering seamless care across the organisational boundaries of the NHS and local authority social care.

The D2A policy model is structured around four discharge pathways, with the assumption that most people (around 95%) will recover at home, with or without additional support from health and social care. Up to 4% of people will need recovery time in other bedded care, but with a core objective of regaining independence and returning home. Short term Pathway 2 beds should not be a transition into permanent residential care. Similarly, for those people being supported in their own homes following discharge, there should be active recovery plans that reduce their need for intensive support in the longer term and enable a return to a quality of life and engagement in activities and roles that matter to people.

As we have argued, the Discharge Pathways require a different service response, and typically one that is multi-professional and therapy-led. Ensuring that the right pattern and volume of services is available (across health and care, but also from the voluntary and community sector) requires whole system approaches to understanding demand and capacity and developing responsive commissioning strategies.

Discussions with participants indicated considerable consensus around the key challenges, and similar reflections on recent experience. It was clear that the key purpose of D2A needs to be outcome-focused, and not seen simply in terms of getting people out of hospital. Over the past two years there has been an accelerated development of community-based models of care geared both to admission avoidance and supporting timely discharge. However, there remain some significant challenges in maintaining momentum and embedding D2A as the standard approach to delivering a recovery-based model of care, particularly around the pattern of service investment to deliver community capacity and ensure the availability of the right workforce.

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