Based on his work with a number of organisations across the UK, and with reference to other published reports, Professor John Bolton has structured his considerations using a basic commissioning cycle – analyse, plan, do and review. He summarises his considerations for planning and designing service for effective discharge as:
- Having a good understanding of the patterns of demand so that, at the point of discharge, a range and sufficient supply of the required services is readily available, including some residential intermediate care beds as well as support in the community.
- Many delays are caused by patients waiting for an “assessment”. Those planning discharges should always consider whether an assessment in hospital is the best place and whether many of the important aspects of an assessment could take place in a setting outside hospital – preferably at the person’s own home.
- As the needs of some people are frequently overestimated by some professionals at the point of discharge, a more timely and systematic mechanism is needed that identifies people who, when in the community, require less or no further support.
- The services that should be available at the point of discharge should in most cases offer short-term help that focuses on supporting recovery and recuperation. These services must involve therapists, nurses and care workers, all of whom share the outcomes focus.
Professor Bolton concludes that it is not possible to eliminate all potential delays at the point of discharge. There are isolated situations that do require a complex assessment such as when it is considered that an older person may be being placed in or returned to an abusive situation or where a person’s health needs are complex and require specialist attention. These should be marked out as the exceptions not the day to day activity. However, health and local authority commissioners should ensure that there is adequate supply of the right types of care and support at the point of discharge there should be fewer delays. Supply of care can be scarce as there are only so many care beds or hours of carer time available in any specific area and much of this resource is committed to people with longer term needs. The supply of care has to be well managed and providers should be held to account for the outcomes they produce for older people. This in turn both reduces the overall costs and delivers the best possible outcomes for older people.
