Supporting people to leave hospital

During 2022-23 we supported over 4,000 people to be discharged from hospital ensuring fewer people stayed in hospital longer than necessary. We recognise, however, that hospital discharge is an area for further improvement.

‘Discharge to assess with reablement’ services    

‘Discharge to assess with reablement’ services are designed to support people to regain as much independence as possible after they leave hospital by providing reablement in a care home in the community, with 24 hour care and support available.  Social care workers, occupational therapists and care staff are on hand to assess any ongoing care and support needs and to provide assistance to enable people to return to their home wherever possible.

The service plays a key role in ensuring that people who are medically ready can be discharged from hospital and importantly, ensures that no long-term decisions concerning care and support needs are made in hospital.

Between April 2022 and March 2023, 205 individuals were discharged to the service - 61% of people returned home following their stay.

Home First

Home First is a multi-agency approach which enables people to be discharged from hospital directly to their home when they are medically ready. The service is led by Sussex Community NHS Foundation Trust and is supported by social care professionals and care providers and commissioned by the Council. The service supports people whilst assessments for longer-term health and/or social care needs are undertaken in their home instead of in hospital.

Between March and June 2023, 150 people were supported to be discharged from hospital, 80% of whom remained in their own homes after Home First ceased.

Combined Placement and Sourcing Team

In July 2022 our Combined Placement and Sourcing Team launched a service which focuses on finding sustainable care solutions for people who need lifelong services and for people of working-age with mental health needs. The aim is to reduce the number of delayed hospital discharges, whilst also preventing admissions where possible, and fully utilising relevant block-booked and directly provided services within West Sussex. This team is proving highly effective in managing these referrals making the best use of our resources by accessing appropriate care and support for people at the right time.