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Supporting transitions from hospital to home

15 February 2016

Lisa SmithLisa Smith, Research and Development Manager at RiPfA, discusses the latest NICE guideline, reflects on the need for it, along with the development process, and looks at how it could be instrumental to support best practice in this area. 

We know from experience that our health and care systems don’t always work well together and that sometimes a result of that is that people get stuck in hospital when they’re medically well enough to go home. Or that people get discharged from hospital without the right support in place. Neither of these are positive experiences and can lead to negative outcomes for people both in terms of their health, but also in relation to their wellbeing. So having a guideline that sets out good practice in transitions feels like the right thing to do, if its aim is to improve the experience of being in hospital for people and their families.

There is also a monetary driver for this piece of work - acute trusts are measured on DTOCS (a handy acronym to describe Delayed Transfers of Care) - amongst other things.

A DTOC is when a person is clinically fit to be discharged but they can’t be discharged from hospital because there isn’t the right support in place. This could be social care, community health services, housing, or care home placement.

Trusts are fined for DTOCs, so if we get the transfer right, there’ll be more money available to provide more support and care, rather than paying for mistakes.

I’ve been leading support for implementation of this guideline for RiPfA as part of our role in the NICE collaborating centre for social care (NCCSC). It’s been a really interesting role which has included attending guideline committees to listen to the discussions taking place. The guideline committee is made up of people working in the sector, and people who have experience of using services, or those with caring roles. The mixture of the group has led to lively debate and a healthy level of challenge. Hearing from the systematic reviewers as to the available evidence on this topic was  a particularly rich experience for me, and reminded me of my time at University and as a researcher, when I had the time and opportunity to really immerse myself in particular research articles. If you’d like to hear the perspective of one of the Guideline Committee members, here’s a great blog that gives a bit more insight.

My role was usually to get the group discussing some of the thorny issues around ‘how do we implement this, what are the barriers, what are the enablers?

Looking back at one of my earlier presentations on this, we were clearly a very positive bunch, as the enablers outweighed the blocks seven to two!

Some of these included linking to the Care Act 2014 and other statutory frameworks and being clear on our message when we launch about why this guideline is useful.

So why is it useful?

Well, it’s useful because it sets out some clear ways of working to support effective transitions from hospital to home. The impact of this is that the individual has a better experience and that resources are freed up in the local health and care system and access to services is improved. All in all a great idea.

If you want to find out more the guideline can be found on the NICE website. And RiPfA will be running some workshops on this along with three other topics this year – keep an eye on our Training and events calendar for details. 

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