Discharge to Assess (D2A)

Scope of this chapter

On 1st April 2022, new Discharge Guidance was issued. This new guidance replaces the previous Discharge Policy.

See: Hospital discharge and community support guidance.

This chapter highlights the key changes and implications for our practice, and how to access further information and supporting documents.

  1. All action cards and letter templates are no longer to be used
    1. The guidance document does set out specific responsibilities for organisations and teams.
  2. D2A is no longer mandated – it is up to local systems to decide how best to tackle and process discharge – but D2A is cited as the best practice;
  3. There is no more HDP – therefore there is no 4-week funded period for anyone. We revert to the old intermediate care and 9 High Impact Change models;
  4. The pathway descriptors and expected percentages remain unchanged;
  5. Schedule 3 of the Care Act is revoked, removing the requirement for Care Act assessments to take place prior to discharge (this was always incongruous to the Policy anyway, as all assessments for any long-term care should be made post discharge, and that continues);
  6. LAs and ICBs as commissioners of health & social care will work together to address the demands, but all domiciliary care and care home care should be LA led;
  7. Funding is by local agreement and mechanisms – commissioner does not necessarily mean funder – and joint commissioning with agreed leadership for each element is the way to go, using pooled budgets such as BCF, etc.
  8. Each system must have 1 Exec lead and 1 Coordinator, who holds others to account for the processes and resolution of flow issues:
    1. Metrics for performance monitoring and improvement required.
  9. Carers and those who may not identify as Carers, but yet perform the role must be included in all discharge planning;
  10. GPs and other primary care providers must also be included;
  11. Early discharge planning by acute teams must be in place to identify, as early as possible, any likely barriers or issues that may delay discharge;
  12. Community TOC teams to be set up to manage the post discharge process including follow up and contact:
    1. TOCs should have case managers present and can comprise actual service providers;
    2. Should include Housing.
  13. SW presence in acutes is described as 'essential', particularly for more complex people;
  14. Personalisation must be at the heart of planning:
    1. BUT, whilst choice can be exercised, in times of surge we can elect to restrict some options as long as it is recorded in notes;
    2. The capacity of the patient is key: in disputes with carers/families etc. the patient’s wishes are prime, and it is up to the teams to sort out safe care.
  15. Criteria to Reside are being revised to make them less medical, more clinical, and safety oriented.

Last Updated: September 22, 2022