What does Discharge to Assess mean?
Discharge To Assess means that people discharged from acute hospitals (short-term care) are assessed by social workers at home or in the community, rather than in a hospital setting.
The change was driven by the Covid-19 pandemic. Hospitals needed to dramatically reduce the number of people attending, to accommodate all the new patients. The government subsequently suspended the Care Act, which is where Assessment, Discharge and Withdrawal was originally managed.
The new guidance stated that hospitals should aim for the rapid discharge of all clinically ready patients. The goal is for transfer off wards within one hour of a discharge decision, at which point patients are moved to a designated discharge area. From there they are discharged within two hours.
NHS Discharge to Assess
Discharge To Assess will be the ongoing standard in England for discharges from Acute Hospitals into Social Care, and there are plenty of benefits to this.
In 2016 Professor Martin Vernon (National Clinical Director for Older People and Person-Centred Integrated Care at NHS England) wrote about the potential success of introducing Discharge To Assess. In his article he spoke about the positives – particularly for the elderly or those with long-term conditions (LTCs).
His article uses data from the National Audit Office (NAO) in 2015, which showed 1.75 million hospital bed days lost because of delays in the transfer of care. On top of that, 4.2 million beds were held by people who didn’t need acute hospital care anymore.
The impact of this is twofold. Firstly, and most obviously, is the blockage of new patients using those beds, but secondly is the impact on older people. According to the NAO, 10 days of bed rest for healthy older people can cause up to 10 years of muscle ageing due to being idle. This decreases independence and freedom and increases the chances of injury or illness.
With the introduction of Discharge to Assess, these problems are overcome. Patients are being discharged from hospital an average of three days earlier than before. NHS England has stated previously that longer stays in hospital lead to worse outcomes – especially for older people. By moving assessments into the community there’s a reduction in the burden for hospitals, greater comfort for patients, and better data provision for social workers – saving an estimated 13.5% of their time courtesy of the improved record keeping.
“Wherever possible, people should be supported to return to their home for assessment. Implementing a discharge to assess model where going home is the default pathway, with alternative pathways for people who cannot go straight home, is more than good practice, it is the right thing to do.” - NHS England
Discharge to Assess model
The Discharge to Assess model is built around the idea that hospital stays should be short, and assessments should be swift. Sometimes referred to as “Home First”, this model does vary from one NHS Trust to another, but the core principle is the same – don’t keep people in hospital longer than they need to be.
There are pathways within the model to account for different discharge locations, whether going home, into rehabilitation, or to a residential home. People are to be discharged from acute hospital stays as quickly and safely as possible, to then be assessed in the comfort of their own homes or their local community.
These assessments check not only the patient’s condition, but also the environment they’re living in and what care they will need going forward. In most assessment cases people are seen within the first 24 hours of discharge, and if they need additional care the local authority can move them to appropriate facilities such as a care home for as long as needed.
Delays in 2021 affected 20.8% of transfer of care cases. Patients were left waiting, frustrated, when all they want to do is go home. Hospitals were also left frustrated, desperately in need for any and all beds for other people.
The difficulty comes when transferring patient information from a hospital to the local authority. This is where the Discharge to Assess guidance comes in, with three branches to the model: care data, locator, and referral services.
- Care Data Service: Used at the point of admission and during a hospital stay. Gives healthcare workers access to social care data, including patient details, GP details, assessments, and safeguarding protocols.
- Locator Service: Shows care staff which local authority a person resides in. Accurate to a property level and provides an end address for post or email.
- Referral Service: Digital discharge from hospital to social care, ready for assessment. Allows for joint case management between health and social care professionals. Real-time updates.
The model also accounts for redeploying and retraining staff. Therapists are being taught basic nursing duties so they can work in intensive care alongside existing staff, and domiciliary care teams are learning basic wound treatments to save hospital trips back and forth.
Discharge to Assess policy
The Access Group (formally Servelec) is working with Nottinghamshire County Council to enable the proper sharing of information between the Council and local healthcare trusts.
“Nottinghamshire County Council have been trailblazers in developing a solution that enables social care staff to view a person’s up-to-date health information, which saves time and enables them to be discharged more quickly and safely from hospital. This has not only benefited our staff but also has helped to free up hospital beds and ensure people are supported to return to independence in the right environment.”
Melanie Brooks, Corporate Director for Adult Social Care and Health at Nottinghamshire County Council. Read more about our Nottinghamshire County Council case study.
This partnership uses our Viewers and Application Click throughs, which is a tool to share patient information easily and quickly. The software meets FHIR standards and is backed by NHS Digital Pathfinder funding, and the result is real-time access to personal care data, with strong security to protect personal privacy.
Below is a rundown of how Discharge to Assess NHS England works for patients and staff, and how software partnership can facilitate improved healthcare nationwide.
Improving the patient experience aka “How it works”
- Referrals are sent right first time to the correct Local Authority
- The referral is regularly updated with any changes to the patient's information
- Patients and carers will now not need to provide information multiple times
- Information is provided by the Care Data Service
- Patient’s average length of hospital stay is reduced by more than three days
- Patients are discharged from hospital quicker and can continue their recovery with the appropriate care package in place at home/community setting
Helping social workers provide the right care
- Social workers can better manage their time as referrals arrive on time and are updated real time if anything changes
- Notifications of patient death means they can offer appropriate support to a bereaved family
- Notification of changes to patient's location means they no longer waste time contacting the wrong ward
- These simple but effective changes allow them to be more time efficient as they are constantly updated about the person’s situation
- Able to arrange timely intervention with the right services
- Reduces manual work significantly
- Can view updates to the case at a glance using the Case Management Log in Mosaic
Helping services use resources more effectively
- No delays and errors reduced
- Reduction of inefficiencies from the digitisation of the process
- More up to date information allows for better ability to plan workforce and provide better care
- Appropriate next steps for care can be arranged in a timely manner
- Improved service delivery
- All information received electronically, directly into the Mosaic record reducing manual work
If you’d like to find out more about the change to Discharge to Assess, please get in touch.
