At our recent annual conference, Helen Whately, the Minister with responsibility for Social Care joined us for a key note presentation. In it, she was quick to reference the need for providers to ‘step up’ to make sure as many people as possible got home for Christmas.
Whilst the annual drive to ensure people leave the hospital before the clock strikes on Christmas Eve is vital, it never seems to achieve the outcome that is on everyone’s Xmas list – that of a reliable discharge process that has people, not systems, at its heart.
In the spirit of Christmas Future, our members have compiled a list of things that would support people to get back to where they want, as quickly as they can, at any time of year – not just Xmas!
- Maintaining as much independence in hospital as possible – people need to be supported to be as independent as they can be whilst in hospital to ensure they are strong enough to return home. This is not just around mobilisation, but ensuring that areas such as continence are accurately assessed or understood at the point of admission, and that particularly people with dementia are not assumed to be incontinent, leading to continence problems for the future.
- Accurate, comprehensive assessment to support discharge – It is vital to have proper accurate, up to date, comprehensive information for the care provider about the needs of the person being discharged to ensure that the care provider has all the information they need to see if they really can meet the needs of the person being referred. Of course, transitions always include risk as people are moving from one environment to another, however, care providers need the best, most accurate, most honest picture we can get.
- Timely planning – Aim to give as much time as possible to the care provider to plan for the care being sought. A few hours’ notice does not work when sorting rooms or rotas, and therefore as many days’ notice as possible will be vital.
- Clear points of contact – being clear who the first points of contact are for care providers and families so that they know exactly who to contact in the hospital discharge teams.
- Effective information flow – make sure all the information is shared in advance with the care provider.
- Proper transfer of the person and all their essentials – the usual ‘red bag’ staff – meds info, discharge notes, their glasses, hearing aids, teeth, etc!
- Realistic contracting – Winter pressures are now year round pressures and therefore it is important to recognise this in the commissioning and payments arrangements so that social care providers are able to offer holistic rehabilitation services. Providers need the right resources and costs to be built into long term contracts to support rehabilitation alongside long term care.
- Realism and honesty with families and unpaid carers – People need a clear understanding of what they will need when discharged and how they can be supported to recover well at home, avoiding precipitating further crises that threaten future independence. Families often don’t class themselves as ‘carers’ and often have no idea what they’ll need for it all to work when someone returns home.
- Culture – It is important to have mutual respect between health and social care staff. Whilst there are many wonderful examples, colleagues felt that it was sufficiently inconsistently applied that it needed to be on this list.
- Invest in your care provider leadership – Take the opportunity to see social care as strategic partners in the system – not just business to be contracted with – and you will reap the benefits.
So whilst we all pull out all the stops to meet these hugely challenging times, it is important that both health and care call out for the need for the discharge process to be put squarely on a permanent, respectful, person centred basis. Whilst it remains the headline grabbing challenge that it is today, this only serves to put fear in the hearts of people, and tension between the ‘two sides of the same coin’ that we are all so keen to manifest.
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