Discharge to Assess Care Home Forum - PowerPoint Presentation

1. Discharge to AssessCare Home Forum23.3.2023

2. Hospital Discharge/Discharge to AssessCare Act 2014 – Delayed Transfers of Care. Complicated counting system but broadly ASC had a minimum of 3 days and a maximum of 5 days to assess, put services in place and achieve the discharge19th March 2020 – Under national covid legislation, the Hospital Discharge & Operating Model was published. Mandated a discharge to assess (D2A) process, giving 2-4 hours to put services in place and facilitate discharge.October 2020 – Policy was refreshed. D2A still mandated. Timescales: aim for 2-4 hours, but certainly within the same dayJuly 2021 – Policy further refreshed to become the Hospital Discharge and Community Support: Operating Model. Discharges should happen within the same day, ideally within 2 hours. All discharges must be safe.1 Jul 2022 — Section 91 of the Health and Care Act came into force on 1 July 2022. It revoked procedural DToC requirements in Schedule 3 to the Care Act 2014. D2A is the preferred model but not mandated. Discharge should happen within the same day, ideally within 2 hours. All discharges must be safe.

3. Not Meeting Criteria to Reside (NMC2R)‘All people who no longer meet the clinical criteria to reside for inpatient care in acute hospitals should be discharged as soon as possible, ideally within a few hours, mostly the same day’NMC2R ‘delays’ – anyone identified as ‘NMC2R’ and still in hospital at 11am the next day.National target – no more than 5% of total people occupying the hospital NMC2RLSC Picture – 22nd March 2023 Total Number of Patients Not Meeting Criteria To ResideTotal Number of Patients Not Meeting Criteria To Reside Minus Discharge dateNumber of Occupied General & Acute ADULT Beds (LSCFT number of Adult / PICU Patients)% Total NMC2R of ADULT GA Beds% NMC2R Minus discharge date of ADULT GA BEDS7 Day LOS % of ADULT GA BedsBlackpool12311275116.4%14.9%55.0%East Lancs49436647.4%6.5%49.4%Lancs Teaching58418197.1%5.0%53.5%Univ Hospital Morecambe Bay1109957219.2%17.3%51.4%LSCFT801840419.8%4.5% HLSC Total4203133,21013.1%9.8%52.5%

4. Bed Based Discharge To Assess – The ‘Process’The Hospital does an assessment of need, and completes a nursing needs assessment if this level of support is indicatedDepending on the hospital, the social care team may scrutinise and participate in the decision makingDepending on the hospital, the sourcing of the placement is undertaken by LCC, the CSU (NHS Commissioning Support Unit) or the Hospital themselvesPlacement secured, person and where appropriate family/carer confirms agreementAdmission date agreedHospital arranges dischargePerson followed up by LCC and/or NHS

5. ChallengesAccuracy of hospital’s assessmentAccuracy of information about the person’s needsChoice is limited under ‘D2A’ due to required speed of discharge, and severely limited when the Hospital is formally at ‘OPEL 4’Speed of discharge requiredWhat happens if the discharge is poor/unsafeCommunication about the dischargeTimeliness of follow-upShort term nature of the D2A placementTime taken to settle in/register with a GP/draw up care plan etc

6. Challenges – cont.Wide range of fee ratesLack of contract with the Care Home and with the person/familyFee rates at the end of the ‘D2A period’Potential multiple moves for the personLack of therapy inputDOLSWhere the person’s needs change or exceed the registration of the current placement

7. Bed Based D2A SpecificationWorking up a consistent Bed Based D2A SpecSets out the service to be commissionedExpectations of the Care ProviderExpectations of the NHSExpectations of the Social Care TeamConsistent fee rate for services provided‘Grace period’ if the person is readmitted to hospitalNHS and Social Care to operate to the same specification

8. Challenges – provider perspectivePlease tell us what the issues are from your perspective