NHS Discharge : Home First Scheme

Discuss news stories and political issues that affect carers.
An interesting article from the later edition of today's Guardian :

https://www.theguardian.com/social-care ... ital-wards
'Home first' model aims to stop patients being stranded on hospital wards.

The quicker older people get out of hospital, the less likely they’ll end up in residential homes or back on a ward.


A snippet follows .... full article with a couple of case studies worth reading :
With winter looming, health and care teams are being urged to radically overhaul discharge procedures to prevent patients being left stranded on hospital wards. New approaches are yielding striking results that could help avert a beds crisis – and improve older people’s chances of continuing to live independently.

The latest thinking on hospital discharge is to get people home and then carry out assessment of their support needs and rehabilitation. Hospital trusts and their community health and social care partners are being encouraged to adopt a “discharge-to-assess” (D2A) or “home-first” model.

Where the models have been tested, the number of patients subject to delayed discharge has plummeted; the number of patients going into residential care has also shrunk dramatically – in one instance, almost to nothing.

“We can see that the impact of D2A is huge,” says Liz Sargeant, clinical lead for the national emergency care improvement programme. “Ten days in bed for patients over 80 is equivalent to 10 years’ ageing of muscles.”
Hospital to home: people's needs must be central to transfers of care

This deconditioning means that some people go into hospital never to see their own home again. “Yet people can instead be discharged, then supported in their own homes,” says Sargeant.

Images of people waiting for trolleys in A&E and reports of routine operations being cancelled dominate the news every winter, as demand for hospital beds spikes. Nearly two thirds of hospital inpatients at any one time are 65 or older, according to the National Audit Office, while delays in discharge, or “transfers of care”, are almost a third up on 2014. That’s equivalent to almost 6,000 beds a day being taken up unnecessarily, with 55% of delays attributed to the NHS – principally “patients awaiting further non-acute NHS care” – and 37% attributed to social care, principally patients awaiting a care package for when they return home.

Measures announced in July aimed at prompting councils to cut delays on the social care side have proved controversial. Critics have questioned the rationale of threatening to cut funding for councils that fail to respond. But part of the drive to free up as many as 3,000 extra beds is based on an expectation by NHS Improvement (NHSI), the agency that works with care providers, that hospitals will adopt the D2A model as good practice and have just one person carry out needs assessments.


At first glance , a well worthwhile scheme .... as run by the NHS , I presume free ???

Colour coding to follow ... quicker to discharge a patient than fill up an INK bottle ???
Well, the instant problem I foresee is that at a stroke, the ONLY 'pressure point' that most families can exert on the NHS/SS to get home-based care (ie, professional care workers/OT etc etc) SORTED out BEFORE discharge, has instantly been lost.

It was only the gun that 'unsafe discharge' pointed at hospital heads that got them off their (admittedly overworked!) backsides and made them pull their fingers out to sort out home care FAST.

With this new system we can immediately forecast that the elderly etc will be blithely chucked out of hospital back to their collapsing families, who will then have to wait weeks for the SS to sort out the home-based care workers and OT that are required.

As usual, families are expected to pay the price.....

I've just seen this very thing happen with my friend whose MIL was taken into hospital, who has already been sent home BEFORE the care package has been set up - so my friend now has to do all the MIL-care HERSELF probably for weeks etc. I specifically WARNED her NOT to allow the hospital to discharge without it being set up, as it was the only gun she could point at them, but of course the MIL WANTS to come home and her own son isn't going to be doing much/any of the care himself anyway! I fear they can whistle now for care-workers - or have to pay for them privately themselves.....
Excellent point ... I hope the NHS are not playing the same " Smoke and Mirrors " game so beloved by the Government ?

Only time will tell IF the NHS is , in fact , in sole charge of all procedures from discharge to home.

One organisation , own team .... no third party involvement.

Could be " Interesting " when the NHS decide to end their role , enabling the LA to step in ... and the paperwork goes missing ?

At that point , usual considerations will apply ... free at one moment , means tested the next ?

Still , early days .....
I don't believe this will work in my area. There aren't enough carers to go round, and mum was chucked out supposedly "fit for discharge" several times when she wasn't fit for discharge at all, twice readmitted within hours. The real problem is the system for assessing fit for discharge. It seems to be "we can't do anything more for her, so get her out asap" here. The major hospital diagnosed MRSA, then said she was OK. Discharged her to the local rehab hospital. Next time I visited she was being barrier nursed in a side ward on her own, because the MRSA was still active!!!
There are a number of these " Home First " schemes currently in force around the country.

For anyone wanting to the have the full sp , guidelines issued by the NHS in pdf. format :

http://www.nhs.uk/NHSEngland/keogh-revi ... access.pdf

12 pages worth setting out , in great detail , the guidelines.

No doubt , there will be variations on said theme as per our old fiend , the post code lottery ???

Needless to say , the biggest obstacle will be when the NHS hand over to our " Cash rich " LAs ???
Another Issue , allied to discharges from the NHS ... readmissions ... from the BBC web site this morning :


http://www.bbc.co.uk/news/health-41740525

Patients face 'distressing readmissions'

The number of patients in England being readmitted to hospital within 30 days of discharge has risen by nearly a quarter in the last four years, a watchdog has said.

Figures compiled by Healthwatch suggest one in five of these potentially distressing readmissions happen 48 hours after being sent home.

The watchdog warns patients may be being rushed out early.


NHS England says it is impossible to know the reasons for the readmissions.

An emergency readmission occurs when a patient needs to go back into hospital unexpectedly for further treatment, within 30 days of having been discharged.

Readmissions in such a short space of time raise concerns about patients being discharged unsafely, and about the pressure on hospitals to free up beds.

Healthwatch was prompted to look at the issue as none of the official national NHS bodies collects data on readmissions.

It asked hospital trusts to provide information under the Freedom of Information Act.

There were some differences in the way the data was collected, but it received comparable data from 72 hospital trusts, just over half the total in England.

The results showed:

In 2016/17 there were 529,318 emergency readmissions reported by 84 hospital trusts
The number of emergency readmissions had risen by 23% over the past four years to 457,880
One in five of the readmissions were with 48 hours of discharge
There was a 29% rise in people being readmitted within 24 hours


The rise in the readmission rate outstrips the overall rise in hospital admissions, which stands at 9% over the period.

In total, there were 16.5 million admissions last year, suggesting that close to one in 20 patients in hospital may be a readmission.

Healthwatch speculated there could be a number of reasons for this, including patients being rushed out too soon or when there is insufficient support in the community to care for them.

Hospitals are under pressure to bring down the number of delays in freeing up hospital beds because of rising waiting lists for operations and increasing delays in A&E.

Imelda Redmond from Healthwatch England said the analysis "raises some big questions":

"With health and care services being expected to each free up 1,250 beds through reducing delayed discharges, it is vital that these services also watch what is happening to the people being sent home from hospital.

"It's clear that health and care leaders need to take a closer look at why people are returning to hospital so quickly."

But an NHS England spokesperson said: "Current data makes it impossible to distinguish between genuinely unforeseeable emergency readmissions and readmissions that would not be surprising to clinicians.

"We agree that it would be useful for NHS Digital to look these data more routinely - and will be asking them to consider doing so."

Nigel Edwards of Nuffield Trust said it's a sign of the pressure the NHS is under, and called for improved national data to better analyse emergency readmissions.


Obviously , something again seems to be very wrong ... even the NHS do not have the correct data to analysis just where the problem lies , or across several areas.

I'm sure that a few readers will have had direct experience of this ... being sent home too fast just to create more space seems to be a theme underlying the problem ... ?

Who would want a job in a F1 pit crew ... as if that was a standard to set ???
I was told by one Ward Sister that they have to put down a date of discharge down as soon as someone is admitted, and there are repurcussions if they don't! Fine for people who are basically young and fit - I was discharged only 4 days after I had my kidney removed and a 12" incision! but I was OK apart from the surgery. The NHS doesn't understand that the elderly can't bounce back so quickly, because their bodies are frail and lets be honest, heading for death within a year or two whatever they do. I could see my mum on a steep decline but the hospital just talked about "getting better".
The NHS has itself to blame for the current crisis, in my area they shut FOUR "cottage hospitals" at a time when the elderly population in the area was rapidly increasing. Hardly rocket science is it?!
Architects of their downfall by that action of closing the cottage hospitals.

F1 again ... pit lane now being blocked in both directions ... and only room for a certain number of cars ?