Discharge to Assess Service

Date: 29 Oct 2015

Category: Services

Bristol patients are being helped to return home sooner following an inpatient stay, thanks to an innovative new service being launched as part of partnership work between Bristol City Council and local NHS commissioners and service providers.

Patient Care and support

The “Discharge to Assess” service focuses on the routine assessments carried out to establish a patient’s care and support needs following discharge from hospital.

Typically these assessments have been carried out in hospital but under the new service, community teams made up of social workers, nurses, physiotherapists and occupational therapists will provide assessments for people in their home, care home, rehab facility or community hospital. This means patients could be discharged from hospital as soon as they are no longer in need of acute hospital care.

Benefits of the approach for patients include a quicker return home where appropriate, the ability to rest and recuperate in familiar surroundings and less risk from the secondary complications that can be associated with longer hospital stays. If patients need further support before they can return home there are options to receive rehabilitation or nursing services within specialist centres or carefully selected local nursing

New way of working

Welcoming the launch, NHS Bristol CCG Chair Dr Martin Jones said: “Discharge to assess is a new way of working which will get patients where they want to be much quicker than previous processes have allowed. This is good for patients who we know recover much better in familiar surroundings, and also good for the wider health system because it frees up precious acute beds for unwell people who need specialist hospital care.”

Mike Hennessey, Director of Adult Social Care at Bristol City Council, said: “We are committed to putting an individual’s wellbeing and personal preferences at the heart of everything we do and this new way of working reflects that. We want to do everything we can to support people who need our help and we’re constantly looking for better ways to work together to improve people’s experiences of health and social care.”

Julia Clarke, Bristol Community Health Chief Executive. “Providing high quality person-centred patient care is at the heart of what we do, and so we’re always looking for new ways to meet the diverse health needs of our patient. We know they have a common desire to receive prompt and personalised treatment in a place they feel comfortable – for example, in the community or their home. Discharge to assess is a great solution because it enables us to get patients out of hospital sooner, and ensures we provide tailored long-term care efficiently and effectively, alongside local healthcare providers.”

Deborah Lee, Chief Operating Officer for University Hospitals Bristol, said: “This is a very positive initiative which has our full backing. Hospitals are increasingly geared towards delivering specialist, acute care and we know that once a patient is medically fit their interests are best served by being promptly discharged from hospital. This also then allows us to care for the next patient who needs our specialist skills, in a timely way. It is not unusual for us to have 70 or more patients awaiting discharge, many of whom could be returned home or to a community setting closer to their home and family with this scheme.”

Improve patients' experience

The service is being commissioned by NHS Bristol CCG and Bristol City Council as part of measures to improve patients’ experience of urgent care services while responding to the challenges of Bristol’s growing and ageing population.

Delivering more care for patients in the community is a specific priority for the CCG and reflects feedback from patients who say they want easier access to services, in convenient settings closer to home and with more joined-up working between providers.

As part of this work the CCG has worked with Bristol Community Health to enhance and expand community health services to provide the additional capacity and flexibility needed to deliver more care in the community.