Discharge to Assess (D2A) is a pathway model for people who are clinically ready for

discharge from hospital and who no longer require an acute hospital bed, but who may still require care services including short-term, funded support. The ethos is to discharge people to remain in their own home wherever this is possible. This is the ‘Home First’ approach.  However, some people require a period of extended short-term support, assessment and therapy within a bed based D2A service before they can return to their home or to their onward care arrangements.

The proposal in this report is to transfer D2A bed-based service provision from the current range of services in the independent care home sector, to a single site service operated by the NHS.

Resolved – That

1)  the current D2A independent care home contracts held by the Council due to expire on 30 September 2021 be supported.

2)  the progression of proposals for D2A bed-based services to be commissioned by the NHS as a single site NHS offer from 1 September 2021 be supported.

3)  the proposal for up to an additional 30 community independent care home beds to be commissioned for a period of 6 months (ending on 31 March 2022) to support the transition from the current model and to support with the additional demand on the care and health system expected due to winter pressures be supported.

4)  a further report be presented to a future Committee with detail of the D2A service arrangements.

5)  In the event of capacity stresses arising in the proposed arrangements, officers be requested to report back to the Adult Social Care and Public Health Committee to advise on the steps being taken to address this.

There has been a review of the current occupancy and average length of stay data of the current D2A bed-based services (Appendix 1). The current services are disparate and are currently operated across five care home sites plus the Grove Discharge Unit (GDU) service and a temporary Bluebell Unit at the Clatterbridge site. The Multi-Disciplinary Team (MDT) approach to supporting people in achieving their goals and to return home at the earliest opportunity is more complex to deliver across multiple sites. It is believed that a single site offer would enable more effective MDT support to people.

The data show that the average length of stay in D2A bed-based services could be reduced by a single site offer operated within the NHS.

The proposed D2A model would provide a more seamless service to people who may also need ongoing care provided by community NHS and social care services on their return home. It is envisaged that people will experience more joined up care and support.

It was considered whether to continue with the current services and to extend the current D2A arrangements further. However, this is believed not to deliver the benefits of a single site offer provided within the NHS.