Timely hospital discharge to help more people live well and independently at home

More people in Sheffield who need support are living independently and well at home because of work between health and care services to prevent readmission to hospital.

Health and care services across the city are focussing on people who are leaving hospital to support them to return home, or their previous place of residence, wherever possible. Where necessary, they are supported to benefit from a period of rehabilitation, reablement and recovery before they have a longer-term assessment of their needs.

The Sheffield system has a commitment to reduce both the number and the length of time that people remain in hospital when they no longer require acute care.

The Council continues to work towards reducing the number of people who are still in hospital when they are medically fit to be at home to 13% by March 2025.

In terms of the impact on people, this would mean 55 fewer people in hospital beds than there was at the end of February 2024.

As a system, health and adult social care are working together to drive improvements, to ensure that timely discharge is the focus in preparation for winter. This will see further development of home care provision, supporting more people to return home, and the development of the new discharge hub. This includes the introduction of joint roles which are providing support to lead and drive discharge across all areas of the system.

This is all linked to the implementation of the hospital discharge and community support guidance and Sheffield’s hospital discharge plan to improve outcomes for local people.

It’s acknowledged that goals will only be met by the health, housing and the voluntary sector continuing to work effectively together.

The Council has established city-wide partnership and governance arrangements in its Sheffield Discharge Model to work towards a position where people are discharged within 24 hours of being identified as medically fit to leave hospital. A System Discharge Lead is now working as a single coordinator working across the Council and Sheffield Teaching Hospitals NHS Trust (STH) to provide strategic oversight and delivery of hospital discharge.

Councillor Angela Argenzio, Chair of the Adult Health and Social Care committee at Sheffield City Council, said: “It’s vital that we make discharge personal so that individuals and their families have good experiences during their stay in hospital and that they experience a positive, safe, and timely discharge where they are involved in the planning for them leaving hospital.

“We know this can be a very distressing time and how important it is to get this right between all the teams involved. We’re pleased that the System Discharge Lead is now in post and holding Council and hospital teams accountable to make sure that hospital discharge is taking place in the best way.”

In line with local ambitions towards ‘Making Discharge Personal’, Council teams are implementing recording systems to measure individual outcome.

Moving towards this more personalised approach is putting the focus on demonstrating impact on individuals’ wellbeing outcomes and independence and using learning from individuals’ and family members experiences to continually improve the approach to prevention of admission and discharge from hospital.