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Introduction
Long Stay Hospital Discharge
General
6.1 Liaison between the hospital and agencies providing accommodation, care and other services in the community is an essential part of any discharge programme, whether in the long stay or the acute sectors. There are considerable advantages if a representative of the housing provider is also a member of the discharge commissioning team (see paragraph 5.14). Much of this liaison relates to the transfer of lead responsibility for the medical care of the individual from the hospital to the community health and primary care teams, particularly the GP. NHS MEL (1996) 22, the NHS Responsibility for Continuing Health Care sets out the full position in this respect.
Current Guidance
6.2 Planned discharges from long stay hospital care require a great deal of pre-planning and in many cases very sensitive handling of complex issues. Guidance to the NHS in Scotland states that alternative care, accommodation and the services required for the continuing care of a discharged patient must be in place before any discharge from long stay hospital care is arranged. These requirements should be individually assessed before discharge. Where, for whatever reason, any element of the on-going care arrangements are not in place before discharge or are not properly resourced, the guidance says that a patient should not be discharged.
Concerns
6.3 Nevertheless, many in the housing sector have expressed concern about the discharge programme from the long stay hospital sector. Concerns relate to a wide range of different aspects and include: -
General Principles
6.4 The general principles about effective joint working and implementation set out in earlier sections are relevant to the long stay hospital discharge programme, as are the principles of equal partnership, integrated services and user participation. The difficulty appears to be achieving this in practice.
6.5 Approaches that appear to be helpful in taking forward the housing aspects of the long stay hospital discharge programmes are: -
The strategy should therefore include both the bricks and mortar and the issues associated with the subsequent housing services, including for example, tenancy rights issues.
Housing solutions have to be considered in parallel with the specification of the social and health care package so that the housing provision can most closely match the needs of the individual. The different timetables for providing housing and care services need to be kept in mind, (2-3 years for new build housing).
A separate team has been established in both Glasgow City and East Dunbartonshire to facilitate the procurement of housing for the Lennox Castle discharge programme. In Edinburgh, a project manager co-ordinates the discharge programme from Gogarburn Hospital. For best possible integration and joint approaches at all stages, at least part of the team should have a base in the hospital itself. Effective liaison with mainstream professionals is also essential.
Using the existing housing stock as well as creating new provision can facilitate integrating housing for those being discharged from the long stay hospital sector. A number of programmes now involve: -
- new housing provision funded by Scottish Homes and private funders;
- lets of new housing (not specially commissioned) and re-lets from housing associations or other housing providers;
- relets from the local authority, sometimes with adaptations;
- direct purchase of properties on the open market;
- partnership with private or voluntary sector providers, sometimes using the
Scottish Homes Special Needs Capital Grant (SNCG) for new or converted housing.
Most often this relates to adaptations and to the provision of furniture and white goods. Funding mechanisms may well be separate for those but a co-ordinated approach has considerable benefits.
Co-ordination of Assessments of Patients with the Provision of Accommodation and Service
6.6 Getting the timing of assessments right is important. There should be initial broad assessments of expected dependency levels and needs of all patients being discharged which will allow the planning of aggregate provision of the type of housing needed and the level support services to proceed. This will also help in the planning of housing management services that are required. Subsequent detailed assessments of individual patients will then be required before discharge to the accommodation provided so that they can be placed in specific accommodation suitable to their needs. Failure to do this may result in delays in discharge with patients waiting assessment of their needs. Equally, carrying out individual assessments too far ahead can lead to their being outdated and having to be repeated at the time of discharge.
Location of Housing
6.7 Location of housing is important, and plans for housing to replace long stay hospital care should take account of the areas to which patients are expected to be discharged. This is particularly important for discharges to rural areas, where re-lets of suitable existing housing may be few and unpredictable.
Advice and Advocacy
6.8 Advice and advocacy should be available to patients being discharged from hospital on their options for accommodation and services outside hospital. These should be independent services, often provided by voluntary bodies including those representing users and carers.
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Co-ordinated Housing and Care Commissioning Home Link in Glasgow and East Dunbartonshire have developed a co-ordinated approach to the social care commissioning and housing procurement. Assessment of housing, health and social care needs is undertaken first and based on this information Home Link and the Commissioning team take forward the specification for care services and the brief for housing, liaising closely. At the next stage there are continuing links between the social care community and the housing procurement involving the independent care provider
Contact, Stewart Gibb, Project Co-ordinator, 0141 287 4833 |
Discharge From The Acute Hospital Sector
General
6.9 The general principles and procedures applying to long term discharges will also apply to discharges from acute services, but discharges from acute hospitals are usually quicker, and are more likely to involve a return to the patient's existing housing with adaptations where appropriate rather than new or purpose built housing.
6.10 Many of these discharges take place without any need to involve the housing sector. However, there are occasions where a person's existing housing is no longer suitable for them. In these circumstances, the housing provider will often be required to undertake an adaptation, support a move to alternative accommodation or provide grant funding to assist with repairs or upgrading for an owner occupier, e.g. through Care and Repair.
Principles
6.11 The NHS in Scotland's Discharge from Hospital: - A Good Practice Guide identifies three principles of good practice for the discharge of patients from acute sector hospitals. These are: -
Discharge Protocols
6.12 Acute sector hospitals should have a jointly agreed discharge protocol based on the Good Practice Guide. It will include arrangements for home assessments of patients in hospital, which are usually undertaken by hospital based staff in liaison with social work departments. The protocols will normally agree that responsibility for contacting other agencies, such as housing, rests with social work.
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Discharge Protocol In Dumfries and Galloway Royal Infirmary (in common with other hospitals), a home assessment is carried out prior to discharge where there are indications that a patient may have difficulty coping at home. This assessment will: -
The hospital occupational therapist will be involved in the home assessments and in following up on the need for adaptations and small aids. Where more major adaptations may be needed a joint home assessment undertaken jointly by the hospital OT and the community OT will be carried out. The Protocol emphasises the importance of adequate notice of the need for adaptations before the planned discharge. Contact: Sue Welsh, Team Manager, Department of Social Services, 01387 241500 |
6.13 Housing authorities and other housing providers should ensure that their operational staff are aware of the agreed procedures on discharge. Housing agencies should also open up discussions with health boards, NHS Trusts and social work departments to address any local difficulties. Points that may need to be discussed are: -
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