Hospital discharge and preventing unnecessary hospital admissions (COVID-19)

Published: August 2020

This guide discusses the lessons learned from hospital discharge and avoidance during the COVID-19 pandemic. It highlights challenges faced and good practice to prevent unnecessary admissions going forward.

From March 2020 there was urgent pressure to free up 15,000 NHS beds for the anticipated wave of COVID-19 admissions. Hospitals, in effect, closed to all but urgent and emergency care. Government guidance directed rapid discharge of everyone clinically ready. Transfer off wards should be within one hour of a discharge decision to a designated discharge area, and then discharge from hospital as soon as possible, normally within two hours.

Councils responded rapidly to deploy resources and work with NHS colleagues to quickly establish and enhance discharge routes. For commissioners, this was crisis market shaping at pace to meet the demand. Whilst there was much emphasis on expanding existing capacity through care homes and home care, there was also community innovation that enabled choice and flexibility through, for example, direct payments, Shared Lives, micro-enterprises and targeted step-down support.

Tragically, the care sector has been at the centre of the UK COVID-19 outbreak. We must learn from this to address immediate concerns with citizens, carers, workers and providers, not least to prepare for future spikes and winter pressures. Financial pressure is mounting as Government emergency funding is not sufficient to cover the lost income for councils and the costs of delivering their COVID-19 response. Longer-term budget planning is essential so learning underpins strategic plans that address the disproportionate impacts and deliver real choices for people to stay out of hospital unless absolutely necessary, ultimately supporting better outcomes.

Commissioning lessons and immediate action needed

Hospital discharge and avoidance has no doubt resulted in deaths, trauma, limits to people’s freedom and choices, and many people not getting support that is right for them. The other guides in this series set out the devastating impacts of COVID-19, particularly on older and Disabled people, people from Black, Asian and minority ethnic (BAME) communities and on care workers. Commissioners must help ensure all people now get the choice of support that makes a positive impact.

Commissioners should be asking:

  • What has stopped people going home or to a place of their choice?
  • What has stopped people moving on from care homes if that was meant to be a temporary arrangement?
  • Why haven’t people been able to cope at home? What would have helped?
  • What has worked well that we want to build on?

There are some common features where discharge and preventing unnecessary hospital admissions has worked well, and these core principles should remain or become the cornerstone:

  • Leadership – strong local decision-making based on good local evidence has saved lives. Good leadership listens to people and creates the conditions to identify solutions.
  • Choice – people have better outcomes where there is more diverse provision, along with good information and advice to empower them to make choices that are right for them. Good holistic support keeps people connected to their networks and communities.
  • Agile and confident commissioning that develops flexible solutions based on knowing communities and providers well, including local businesses.
  • Co-production that genuinely shapes decisions and understands impacts on people who need care and support, and on carers.
  • Communication and relationships with social workers, providers and community groups are vital. What issues and barriers are they aware of?
  • Integrated and collaborative working across systems, with holistic or whole-family approaches, to reduce hand-offs, delays and confusion.

What are the urgent issues to be addressed?

While urgent issues must be addressed to ensure people with support needs and workers are safe, and that providers are viable, there is also an opportunity to consider the good changes that need to stay in place. We should build on things driven by the pandemic that have been working well and avoid reconstructing things people don’t want. This can inform recovery plans before workers are too quickly deployed back to original roles. Immediate commissioning tasks include:

  • Understand where people have been moved to and who is not living the way they would wish to. Quickly focus on choices – find out where people want to be and ensure the information and advice to support those choices.
  • Use evidence about the risks – quickly understand local impacts and how to avoid repetition of what didn’t go well. This may need particular focus on larger care homes or how specific groups have been affected.
  • Avoid hospital re-admission by maximising independence support and health inputs including through timely provision of reablement and technology. How can your existing contracts and provision support this?
  • Address the trauma that people have faced. This might be via mental health and bereavement support, including for carers and workers.
  • Improve quality of life – what can be done quickly and safely to improve people’s health and wellbeing? Visits, positive relationships, activities, connections, activity, advocacy, carer support?
  • Stabilise the market, but plan for the long term. Which services have done well? Which could do better with some support? Any off the radar such as hospices, carers services, more innovative community supports? What is the ongoing role of mutual aid groups? What are the financial challenges and opportunities?
  • Equalities – understand and address the impacts of hospital discharge and avoidance across different communities.
  • Co-production – people must be at the centre in decisions that affect their lives and in designing services and solutions. People need choice and control so support is built around their strengths, own networks of support, and resources (assets) that can be mobilised from the local community.

Discharge guidance and good practice advice

The Discharge guidance sets out a ‘discharge home today’ policy requiring collaboration and joint working between providers and commissioners to deliver operational coordination and ensure provider capacity. There are four pathways with community health services taking the lead for people needing any level of support under the discharge to assess model (D2A):

Pathway 0

50 per cent of people: simple discharge, no input from health/social care.

Pathway 1

45 per cent of people: support to recover at home; able to return home with support from health and/or social care.

Pathway 2

4 per cent of people: rehabilitation in a bedded setting.

Pathway 3

1 per cent of people: there has been a life changing event. Home is not an option at point of discharge.

There are three stages to the discharge to access model:

  • Stage 1 – Why not home? Why not today? Open

    A clinically-led review (or equivalent in a community hospital setting) involving social care colleagues focusing on ‘Why not home? Why not today?’

  • Stage 2 – Multidisciplinary work to plan discharge Open

    Once the decision has been made to discharge a patient, community health, social care and acute work together (including housing professionals where applicable) to ensure that the patient is discharged on time.

  • Stage 3 – Assessment and care planning at home Open

    Assessment and care planning is then carried out at home. The single coordinator ensures staff and equipment are available to provide for immediate care needs, review and assess for longer-term care packages or end the support if no longer required. This should ideally take place on the same day of discharge. If needed, a care coordinator works with the person in their ‘temporary’ care home to ensure they can move as soon as possible to their chosen long-term care home or return to their own home.

During the emergency period, the Government will fully fund health and social care support packages upon discharge so continuing healthcare (CHC) assessments can be delayed until the pandemic has ended.

  • Making it happen – discharge guidance Open

    • Clinical Commissioning Groups (CCGs) need to work with local authorities to ensure an appropriate market-rate is paid for support. Section 75 agreements can be used to collate additional funding and commission enhanced supply and provision.
    • Staff to be released from their current roles to coordinate, manage and support the discharge arrangements. Multidisciplinary teams to arrange packages of support and equipment for discharge and follow up patients to assess for long-term needs.
    • Delivery of enhanced occupational therapy and physiotherapy to support discharge and recovery.
    • Councils and adult social care to coordinate discharge work with voluntary sector organisations.
    • Councils to lead the contracting responsibilities to expand capacity in home care, care homes and reablement services paid for from the NHS.
    • End of life teams to take responsibility for any ‘fast track patients’ at end of life needing support and step down.
    • Care providers including hospices should maintain capacity and identify vacancies completing the Capacity Tracker daily. They should adopt NHS mail for communication between NHS, providers and social care colleagues.

Good practice advice to improve hospital discharge

Commissioners have an important role in supporting effective systems across health, social care and beyond so people can leave hospital at the right time, to the right place with the right support. This includes governance and market shaping to ensure the capacity and choice of quality provision. It’s much better for a person’s physical and mental wellbeing to leave hospital as soon as medically ‘optimised’ for discharge. Every extra day in hospital adds risks of functional decline particularly for older people. Yet, each year, nearly 350,000 patients spend more than three weeks in acute hospitals. The ‘Where Best Next?’ campaign asks ‘Why not home? Why not today?’ and promotes early planning and multidisciplinary work to ensure discharge is person-centred, appropriate and timely.

'People First, Manage What Matters' sets out ways to improve patient flow and reduce the numbers of delayed transfers by:

  • improving hospital discharge including discharge to the care sector
  • making better use of care at home
  • enhancing health in care homes
  • using trusted assessment approaches.

The LGA High Impact Change Model for managing transfers of care outlines changes to improve health and wellbeing, minimise unnecessary hospital stays year-round and encourage new interventions. It is underpinned by the Ethical Framework for Adult Social Care to support quality outcomes for people based on what matters to them. Key elements of particular interest to commissioners are:

  • Early discharge planning with systems to monitor and respond to demand and capacity. It proposes a ‘place-based approach’ to develop creative solutions which could focus on, for example, health inequalities or risk groups needing targeted support post-COVID-19 infection.
  • Home first as the preferred option, rather than by default to bed-based care.
  • Discharge to assess (D2A) with a single point of access and multidisciplinary working for holistic approaches and to remove handoffs.
  • Engagement and choice. A hospital is not the right environment for people to make long-term decisions about their ongoing care and support needs so assessments should be at home with families, carers or advocates, after reablement or rehabilitation if required.
  • Trusted assessment using asset- or strengths-based approaches to build on people’s skills, networks and promote their connections and independence.
  • The use of effective housing, home adaptations and assistive technology services to enable people to live as independently as possible.
  • Improved discharge to care homes when that is the choice.

Challenges in transfers to care homes

The likelihood of UK homes being infected with COVID-19 triples with every additional 20 beds. In homes with fewer than 20 residents, the chance of an outbreak was 5 per cent, but in homes with 60 to 80 residents the likelihood was between 83 and 100 per cent. The average UK care home has around 36 beds, HC-One, the largest provider of private care homes, averages 50 beds. Care UK, another major chain, averages 66 beds.

The Office for National Statistics found that regular use of temporary ‘bank’ staff who worked across several homes – a common practice among larger operators – increased the risk of infection more than one and a half times.

NHS England report that 25,060 hospital patients were discharged to care homes between 17 March and 16 April 2020. Routine testing of all discharges only began on 16 April, by which time there were grave concerns about personal protective equipment (PPE) shortages and that older people would be especially at risk. Some local authorities pre-empted the devastating risks of transmission; they quickly closed care homes to all new admissions and began their own testing programmes, such as in Hammersmith & Fulham. However, care home discharges (as a percentage of all hospital discharges) across England doubled in late March from two per cent to four per cent.

The issues faced in care homes during the COVID-19 period to date include:

  • More than 29,000 excess deaths in care homes up to 12 June 2020.
  • Over 40 per cent of all care homes reported an outbreak up to 7 June 2020.
  • Outbreaks were up to 20 times more likely in large care homes. High footfall including agency workers, cooks, cleaners and maintenance engineers, going in and out of the largest homes is thought to be a key factor for infecting residents. Non-care staff were less likely to wear PPE and more likely to work across multiple locations than care workers.
  • Lack of access to whole-home testing for all residents and staff plus early difficulties using the national testing programme added to transmission risks.
  • Lack of specialist healthcare going into care homes has resulted in people suffering a range of health complications – not just COVID-19.
  • Residents – many of whom have dementia – experienced distress, confined to their rooms with no outside visitors.
  • Poor or rushed assessments have made it hard for staff to understand the needs of new residents.

Provider concerns

Care home providers raised concerns about risks, viability and rising costs. They are concerned about contractual obligations for staffing levels and activities, and also contingency planning and share of risk with commissioners. Two-thirds of providers said they fear for their future. The UK’s second largest provider, Four Seasons Health Care, went into administration in April 2020, though has continued to operate. HC-One, the UK’s largest care home provider, said occupancy levels had fallen so sharply it was no longer generating cash. This adds worries for individuals and families concerned that provision will collapse.

The National Care Forum’s top tips reflect concerns as to whether discharge guidance would be properly followed advising providers to:

  • secure sufficient fees to cover additional and specialist costs
  • seek guarantees about local community health support
  • insist on testing and COVID-19 status
  • seek assurance about PPE supplies
  • insist that assessments give the right information and clarify what happens if the person’s needs cannot be met following a full needs and care assessment
  • complete the capacity tracker (and nothing else) as the single mechanism for collecting data on COVID cases, bed availability, staffing and PPE pressures.

These concerns need attention but commissioners should not prop up the market at all costs if quality and outcomes cannot be demonstrated. Immediate measures are needed to ensure safe support in care homes and to restore people’s freedoms, but many people need to move on. People need viable alternatives for support in the community to secure their choices and outcomes.

What has helped support hospital discharge and prevent unnecessary admissions?

The examples in this section show a range of approaches and interventions that have supported better outcomes. Some are specific to a particular setting but many could be beneficial with other combinations of support. For example, enhanced health support, connection with family and friends, support for physical and emotional wellbeing will be helpful in any setting. General enablers of good practice include:

  • Support that focuses around people’s networks of carers, families and friends.
  • Community mobilisation with practical support that connects people with local resources.
  • Information, advice and time for people to think through the options that are right for them.
  • Flexibility, confidence and responsiveness of providers.
  • A confident, supported and empowered workforce.
  • Communication, trust and positive relationships with providers including data and intelligence sharing.
  • Use of technology that enhances rather than replaces human contact.
  • Access to health support and advice.
  • Agile commissioning, flexibility of contracts that supports the above.

Local authorities have worked hard to stabilise the sector and ensure the availability of provision for hospital discharge. They have provided funding to providers to support cash flow, sustainability, cover excess costs and extend services. Examples of support in relation to hospital discharge and preventing admissions include:

  • Increased rates for home care and care homes, contingency funds for direct payments and financial support for unpaid carers.
  • Block booking beds to support viability of homes running under capacity to reduce infection risks and securing capacity in infection-free services.
  • Supply of PPE.
  • Local testing in advance of and to fill gaps in the national programme.
  • Funds to support and sustain voluntary and community sector organisations including funding to expand some activity.
  • Workforce support to re-deploy and recruit additional staff or volunteers and provision of training.
  • Funding crisis accommodation for people with learning disabilities and mental health needs.

Actions that have helped discharge and reduced transmission in care homes

The impact on people in care homes has been devastating, so ensuring safe support is a priority along with enabling alternative choices through other support options. Isolating infected care home residents is recognised as essential, but transmission within and across care homes has continued. It is vital to address this before any second wave. The following actions have helped deliver safer and quality support:

  • ‘Cohorting’ residents or creating ‘bubbles’ has helped minimise transmission and deal with outbreaks without residents always being confined to their rooms. Flexible use of space and care corridors enable staff to avoid crossover of those caring for symptomatic residents.
  • Regular testing and re-testing to confirm COVID-19 status and obtaining written confirmation for new referrals. Accepting no new or returning residents unless they can be supported safely.
  • In Ealing, the NHS opened a special unit to accept infected care home residents as well as infected hospital patients prior to discharge to homes.
  • Minimising outside infection risks to staff by providing transport or car pool so they do not have to use public transport.
  • Clear and consistent messages about the use of PPE and training on infection control for care home staff.
  • Appropriate medical care to prevent urgent admissions. Examples include video call ward rounds to care homes and follow up calls to relatives; establishing ‘virtual’ GP and pharmacy appointments for residents via iPads.

Emotional support is vital for people’s health and wellbeing. Relatives have also faced anxiety and some care homes have been really creative helping families to stay connected with innovative visits or virtual link ups. Many staff have gone above and beyond: there are examples of workers moving in to minimise risks and to ensure continuity of care.

The work for staff during COVID-19 has often been intensive and isolating. Some providers and councils have provided support such as access to a clinical psychologist, mindfulness and counselling, daily check-ins, more frequent informal supervision, WhatsApp groups and virtual team meetings. Recognising the difficulties is important as is finding things to celebrate and bring enjoyment to people.

People feel supported at every level; if we can get through this together we can get through anything.

Portsmouth

Use of hotels and building based resources

There are examples of step-down facilities being quickly mobilised and staffed by councils, CCGs and nurses to support people who no longer need to be in hospital.

Buckinghamshire Council made up to 240 beds available as a care and reablement centre within just three weeks, staffed by care workers and a team of volunteers. This supports people leaving hospital but unable to return home, as well as those who live at home but may need temporary short-term support.

Reading Borough Council is paying for use of hotel rooms at a local Holiday Inn. This operates as a ‘discharge to assess’ facility, allowing time to arrange care packages and equipment for people due to go home. Others are staying in the hotel to protect shielding relatives, or self-isolating with COVID-19 symptoms.

Hammersmith & Fulham made similar arrangements with Novotel but these were stood down when capacity was not needed. Astute commissioning enabled good ongoing relationships with the business whilst avoiding expensive contractual commitments.

UK hotels offer respite to non-COVID patients (The Guardian)

Rapid discharge and enablement pathways

Many areas built on existing home-first work (D2A), and enablement approaches to tailor support and provide a ‘safety net’ for the home. Some areas moved occupational therapists (OTs) to frontline calls to provide or advise on reablement, home equipment and adaptations so people did not lose skills and independence. Other examples that commissioners may want to build on as ongoing approaches are set out below.

The Reactive Emergency Assessment Community Team (REACT) focuses on preventing avoidable admissions in Ipswich and East Suffolk. The integrated team provides a medical crisis response, care home initiative, reablement, specialist dementia support and emergency department front door therapy services.

Accelerated by the crisis, the model was enhanced and integrated with locality Integrated Neighbourhood Teams (INTs). A discharge hub operates seven days per week, and nursing and therapy capacity has shifted from acute to community. Central REACT clinical triage coordinates a localised response from neighbourhood teams within two hours for stable crisis referrals and a specialised response for complex crisis referrals with local team follow-up once stabilised. This has resulted in better patient outcomes, smoother pathways, care closer to home, reduced hospital stays (and associated decline), and lower overall costs.

Portsmouth worked on improving flow by accelerating their home first approach. Hospital social work staff were deployed into the community to assess people within 24 hours of discharge. A central hub deals with step-up and step-down referrals with ‘hotlines’ for hospital and community in-reach teams. Length of stay has reduced from four or five days to less than one day.

In Somerset a comprehensive systems approach links hospital discharge and avoidance with Community Connect to maximise local support and connections. Outcomes through rapid response are enhanced by a locality neighbourhood approach and innovative micro-providers delivering a wide range of flexible support.

Community mobilisation, micro-enterprise and practical support

The amazing community mobilisation across the country has supported people with food, delivery of medicines and PPE, and kept people connected with phone calls. This practical support and community connectivity provide confidence and reassurance that makes the difference for someone to feel OK being at home.

Somerset Community Connect has demonstrated how strong community partnerships helped the response to the pandemic. Building on their existing platforms, they adopted a strengths-based and community-led approach to supporting those at risk during the crisis. People shielding are contacted by village agents, social prescribers and district officers. Alongside the voluntary community and social enterprise (VCSE), they coordinate practical support and supplies – 1,300 volunteers are signed up as corona-virus helpers. People are linked with community groups such as neighbours helping neighbours and numerous activities including the 16 talking cafes that are continuing online. Support is truly local and personalised with 575 micro-providers supporting 2,300 people with a range of needs each week.

Practice example: Somerset Community Connect

Enhanced health support and testing across all community options

Enhanced health support and access to testing has helped limit transmission, prevented people going into hospital unnecessarily and enabled people to be discharged safely from hospital. Examples include:

  • A local seven-day public health support and advice line on COVID-19 for care providers.
  • Expert training and advice, e.g. weekly webinar training session on infection prevention and control for providers.
  • Early and easy-to-access arrangements for testing and, importantly, re-testing for people in all care and support facilities (e.g. Bexley with Queen Elizabeth Hospital pathology lab).
  • Sheltered housing and learning disability homes were set up with a SATs monitor and video consulting.
  • Ambulance services providing expert clinical triage for people at home.
  • The Hillingdon Hospital set up a neuro outreach service for patients who were discharged early from a neuro rehabilitation unit, or would have been referred to an inpatient neuro rehabilitation service.
  • Royal Berkshire Hospital adopted an Italian triage pathway for patients with breathing difficulties. Those able to return home are given a pulse oximeter to monitor their oxygen levels and clinicians track patients by phone.
  • Tower Hamlets GP Care Group and Bikeworks provide COVID-19 home monitoring kits including a pulse oximeter, thermometer and blood pressure monitor.

Support by unpaid carers

Most people discharged from hospital go home and are supported by family, friends or neighbours. There are an estimated 4.5 million extra carers as a result of COVID-19, and most existing carers are providing considerably more care. The right help and advice for carers is essential to support this. Commissioners should seek feedback from carers, carers organisations and from carers assessments to understand the needs. Community and health support with access to rapid support when needed must be available to carers.

  • Coming out of hospital describes what can help. What makes caring sustainable is often a range of practical support, combinations of paid support, short breaks, emergency back up and advice rather than an all or nothing input.
  • Practical support quickly in place is vital e.g. PPE, food, the right equipment and healthcare. Peer and emotional support is important as many carers feel isolated and abandoned. Carers often face a huge financial hit so advice about employment, finances and benefits is essential for carers supporting loved ones out of hospital.
  • Support for the use of direct payments including to pay carers for the additional support they have taken on has enabled some people to get the support they need whilst shielding and settling home after hospital.
  • Young adult carers may be facing additional pressures during lockdown. These co-produced top tips, whilst aimed at education staff, provide great advice on supporting and identifying young carers.

Direct payments

Direct payments (DPs) offer choice and control enabling people to put in place support that is right for them. This can be ideal for hospital discharge and flexible support to prevent unnecessary hospital admissions. Examples of recent use include:

  • Targeted information to discharge teams about DPs and early information to explain to people who are leaving hospital how DPs could be used.
  • Support and reassurance to use DPs flexibly to continue to meet needs during changing circumstances.
  • Advice on employing family and household members when other support isn’t appropriate due to transmission risks, including for hospital step down.

Hospices

Hospices frequently demonstrate good practice with compassionate and whole-family approaches. In relation to hospital discharge, the following examples are of note where a hospice:

  • increased inpatient unit bed capacity by 10 beds to support rapid discharge of end of life patients
  • repurposed its wellbeing centre therapy rooms providing extra inpatient rooms
  • re-organised its community team to provide a 24-hour rapid response team in the community linking closely with NHS neighbourhood teams.

Community support

Commissioners in many areas secured extra capacity with homecare providers to ensure ongoing support where needed for people discharged from hospital or for people not able to access regular activities. Person-centred flexible support helps to achieve good outcomes and respond to people’s changing circumstances:

  • Self-managing teams e.g. Wellbeing Teams are by definition flexible and responsive coordinating support around people’s networks. These approaches work well for hospital discharge and can also enhance input when people would otherwise face a bed-based admission.
  • Individual service funds (ISFs) are similarly flexible as providers (e.g. Yarrow) can flex support quickly in line with people’s needs and preferences and make really good community connections.

Shared Lives

Shared Lives offers high quality support for people with a range of needs and is strongly placed to respond rapidly to add local capacity (Growing Shared Lives) including for hospital discharge such as that offered by PSS home from hospital.

Lots of evidence of how it works really well for hospital discharge and back to independence but also builds relationships and connection that is sustained even when people move back home. Lots of schemes taking referrals, fast tracking new carers assessments, using tech to make matches, etc. Now that testing is more widely available, it should make things easier, too. We want to scale this solution up in response to the crisis.

Shared Lives Plus

Shared Lives schemes are already successfully supporting people with a range of health needs, including mental ill-health and acquired brain injury. The Shared Lives in Health report demonstrates potential to use health budgets to effectively support more people with a range of health needs and scale Shared Lives accordingly.

Shared Lives can support reablement and provide a safe, family environment that offers professional, regulated care. In the current climate this is especially relevant when we consider the increased pressure on our health services during COVID-19.

Anna McEwen, Executive Director of Support and Development for Shared Lives Plus

Support for people with mental health support needs

People’s mental health may have been adversely affected during the lockdown. These examples show how local services have reconfigured their offer:

  • South West London and St George's Mental Health NHS Trust set up a 24/7 mental health emergency department for patients in crisis. A dedicated phone line enables people to attend the mental health emergency department and avoid acute hospital emergency departments.
  • West London NHS Trust reconfigured an acute mental health ward to care for patients with COVID-19.

For more examples of how communities and providers are responding during COVID-19, please see LGA commissioning practice resource, CQC and TLAP.

Next steps for commissioning

COVID-19 has shown that hospital discharge can be rapid and support can adapt to help people remain at home. Commissioners should help mainstream approaches that really promote choice, positive outcomes as well as deliver efficiently and at pace. Commissioners need to build evidence to understand what’s helped people return home with the right support and what barriers still remain.

You can’t magic this all overnight. If you are starting from a place of limited choice and collaboration, it will be about addressing immediate risks and building platforms. If you already have a broader base of choice that has worked well, this is a springboard for next steps. Listening to people’s experience is key to co-producing commissioning plans that start to put things right and plan for a more valued future. Planning for next steps must address equalities, choice, risk and assume future spikes. Starting points might include:

  • Reduce immediate risks Open

    Don’t invest in provision that adds extra risks. Work with providers to ensure all care homes, especially larger ones, implement plans to minimise transmission risks. Don’t let contract terms or poor working conditions inhibit necessary improvements. Plans should address equalities and must not compromise on quality of life. Providers should develop these with residents, staff and relatives.

    What are the immediate risks to market sustainability? Co-produce contingency plans that look to the longer term to reshape a more diverse market. Money will need to move away from provision that does not deliver good outcomes.

  • Ensure choice and develop alternatives to care homes Open

    Choice is essential to support good outcomes for people leaving hospital. Being moved to a care home not of your choice or going home feeling afraid and isolated is not a good outcome. Many people are in the wrong place as a result of COVID-19. Help remove the barriers including retaining good joint work with health. Ensure individuals, families and discharge teams have all the support they need so citizens can go home or move on to a setting of their choice with the right support.

    Plans must be inclusive of people with learning disabilities and mental health needs who still face long stays in assessment and treatment units or provision that restricts their choice and freedoms.

    Urgently build community alternatives to care homes and ensure people are aware of these alternatives. With colleagues, communities and citizens, map the range of support that is available and address the gaps. What have discharge teams struggled with? Are home adaptations and tech readily available? What has worked well that can scale quickly? Investing in good support for direct payments, community innovation such as micro-providers, self-managing teams and Shared Lives is wise commissioning at any time – they deliver better outcomes, support local economies and are better value for money.

  • Build on community connections Open

    People are not separate to the communities in which they live and work. Many local businesses have contributed to a fairer supportive response, neighbours have helped neighbours, supposedly ‘vulnerable’ people have challenged and are paving a better way for others both locally and nationally.

    Carers are part of those communities and their support is vital if people are to have the choice to remain in their own home. Many carers are at breaking point. There must be proper investment in carer support – it is the right thing to do and far less costly than if arrangements break down.

    Understand the role of community support and mutual aid groups in enabling home from hospital. They are essential to connections and practical support – what do they need to continue being part of local solutions including for the longer term?

Support from SCIE

SCIE's COVID-19 hub contains more relevant information including safeguarding, Mental Capacity Act and infection control. It can be used when working and supporting people who are isolated or vulnerable through COVID-19, and can also be shared with community groups.