What steps are being taken in social care to ensure patients are receiving adequate follow-up care upon exiting hospital, in order to decrease the number of long stays?
In cases where people have an onward social care need, we continue to encourage and support joint working between health boards and local authorities throughout the discharge process. A number of measures are in place that help ensure a person is discharged as appropriately and safely as possible once their treatment has been completed and they no longer need to be in hospital.
This includes the Discharge to Recover then Assess (D2RA) pathway. This requires people to be assessed and provisionally allocated to one of four pathways soon after admission. This supports hospital staff to identify what level of support and recovery a person need at the point of discharge, and aids forward planning and the identification of suitable onward care as early as possible, and engagement with appropriate social care or health support services as necessary.
We have also published updated hospital discharge guidance for frontline staff to support discharge, which sets out key tasks, standards and expectations of each relevant partner organisation involved in the process and places an emphasis on ensuring discharge is undertaken in an appropriate, safe and timely manner.
Our Pathways of Care Delays (PoCD) reporting framework is a formal reporting mechanism that provides health and social care partners with a comprehensive overview of their regional discharge delays so that relevant interventions and actions can be targeted more appropriately. This ensures health and social care teams have a clear position on the areas that have the highest numbers of delays. This on-going monitoring improves collective understanding of the main discharge issues in order to make continued improvements.