Innovative Hospital Discharge Transformation: Norfolk & Waveney Journey

Shaping the Market webinar: Discharge to Assess 28 September 2021 Danny Edmonds Clinical Lead Discharge Transformation, Norfolk & Waveney Health & Care Partnership Nick Pryke Director for D2A Transformation, Norfolk & Waveney Health & Care Partnership

Norfolk & Waveney D2A Journey Increasing staff cost, high use of bedded discharge options, poor culture in some hospitals & national outlier in delayed transfers of care Traditional hospital based discharge model Pre-2000 Quick Guide: Discharge to Assess (www.nhs.uk) National Best practice and evidence Quick Guide: Discharge to Assess (www.nhs.uk) (2016) Context 2/3rds of hospital beds occupied by >65 s and 18% increase in emergency admissions Quick Guide: Discharge to Assess (www.nhs.uk) c. 2015 Small scale pilots/innovation sites at NNUH and JPUH to trial D2A Largely unsuccessful due to needing a system approach 2019 Hospital Discharge Services Requirements (March 2020) Hospital discharge service: policy & operating model (August 2020 & February 2021)) 20/21 Covid discharge funding arrangements end Health & Care Bill Norfolk & Waveney s opportunity to embed D2A March 2021 A potted history

Introduction Case for Change Implement Discharge to Assess (benefits realisation). Modern, efficient hospital discharge approach. Personalised care increased numbers returning home on discharge & reduced reliance on bed based options Able to respond to further Covid-19 surge NHS elective & cancer recovery programme Outliers in LOS, additional bed days lost etc. Challenging system financial position National Policy direction Broad support from socialising the Blueprint inc. ECIST Challenge A further significant transformation Anticipatory/PHM, UCR, D2A & CN&T Complex interdependencies 3 acute hospitals, 2 community providers, 2 local authorities & other out of ICS authorities, providers Ensuring equitable access and experience for patients, families and carers & implementing best practice across N&W to achieve this Public and staff engagement and buy-in Sustaining total commitment Financial position Full benefit realisation (outcomes for patients/service users)

Vision Statement Vision Statement 1 Every person is supported to return home to recover after a hospital stay We will do this by 2 - Discharging people from hospital on the day they have the right to be discharged - Ensuring everyone has a personalised recovery plan on discharge - Assessing people within 4-6 weeks where they may require longer term care and support

Programme Summary What is the project aiming to improve? More people discharged the day they no longer meet the criteria to reside More people to return home to recover after a hospital admission (caring where people live) A better intermediate care offer wraparound, ease of access, progression/recovery plans for all Streamline process putting people & professionals in control Releasing time to care professionals in the right place on the D2A pathway/ F2F with people Better coordination of staff resource Home First Hubs, Community based teams etc. Reduced cost all stages Health & social care interface inc. transition to long term care arrangements, Care Act compliance

What is changing? Workforce transition - acute to community (therapy), social work and others Refresh of Home First Hubs and creating defined community based Home First teams Improved digital & BI offer to support D2A Standardisation of pathways across N&W Restructure commissioned services for discharge inc. greater availability of VCSE Every person on Pathway 0-3 will have a progression/recovery plan Refresh & relaunch of Home First approach public message Professionals having greater time with people face to face FAQs Is it safe? Is it legal? Is it a shortcut? Is it just about releasing hospital beds and the NHS? Do people get choice & control?

Here is some information that you may find helpful relating to all things D2A. The Hospital Discharge Service: Policy and Operating Model (August 2020) clearly sets out the model for discharge. D2A is the process with which to achieve this, using HomeFirst principles. Policy Hospital Discharge Service: Policy and Operating Model (21.08.20) Hospital discharge service requirements: action cards for staff Evidence Professor John Bolton: Commissioning Out of Hospital Services to Reduce Delays (Discussion paper, March 2020). Terminology change: discharge to support recovery and then assess . The term HomeFirst is used in this guide to encapsulate this approach. John Bolton (2019): Reducing delays in hospital transfers of care for older people Newton Europe (2019): People first, manage what matters...Part of the Why not home? Why not today? Series Newton Europe (2017): Why not home? Why not today? Royal College of Occupational Therapists: Embracing risk enabling choice (2017)

D2A webinars (Oct-Nov 2020) 1. Policy, model and pathways: https://www.youtube.com/watch?v=seZaXn97n5E&list=PL6rrXMWFEqXJZEdmEbUu8dO1k0YA5GWbP&index=1 2. Personalisation: https://www.youtube.com/watch?v=cFqv-JPggek&feature=youtu.be 3. Data: https://youtu.be/9itTmztSI6w 4. Joint Commissioning: https://youtu.be/wbwGo3zy0G0 5. Workforce: https://youtu.be/iQQV2A3ilDA 6. Funding and finance: Discharge to Assess Webinar Series, Episode 6, Funding and Finance YouTube 7. Providers: Discharge to Assess Webinar Series - Episode 7, Providers YouTube Here are the 2 statements; one from CSP and the other from RCOT around D2A. CSP: https://www.csp.org.uk/news/coronavirus/workplace-employment-guidance/rollout-discharge-assess-d2a-model- england RCOT: https://www.rcot.co.uk/about-occupational-therapy/rcot-informed-views (if you click on the Hospital Discharge Service: Policy and Operating Model) In addition, NHS England produced this Quick Guide to D2A back in 2016: Quick Guide: Discharge to Assess (www.nhs.uk), a link to the National Audit of Intermediate Care (2018): Slide 1 (careengland.org.uk) and the recently published guidance on the Urgent Community Response (Nov 2020): B0252-Urgent-community-response-2-hour-and-2- days-standards-guidance-30-November-2020.pdf (england.nhs.uk)

Danny Edmonds, Clinical Lead Discharge (daniel.edmonds3@nhs.net )

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Danny Edmonds, Clinical Lead Discharge (daniel.edmonds3@nhs.net )