Home First / discharge to assess

Providing short-term care and re-ablement in people’s homes or using ‘step-down’ beds to bridge the gap between hospital and home means people no longer need to wait unnecessarily for assessments in hospital. In turn this reduces delayed discharges and improves patient flow.

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Some things that people have told us about what works and how to overcome the challenges

  • investing in the first 24, 48, 72 hours with a strong focus on not wasting those hours
  • concentrating on costs to the system, not provider versus commissioner or health versus social care costs
  • establishing system-wide principles between partners and having a single narrative across the system about getting people home as a default option
  • ensuring continuity of care co-ordination from  admission through to discharge
  • linking equipment planning to discharge planning, so that equipment is available at home on the day of discharge
  • setting an ambition for percentage of continuing health care assessments to be completed outside the hospital
  • working with consultants and therapists to build confidence and overcome risk aversion to discharge, using positive stories to achieve a hearts and minds culture change.

National guidance

Examples of local initiatives

Highlighted pages

System transformation and integration

Integrated care has developed significantly since the implementation of the Better Care Fund in 2013 which required the NHS and local government to create a local single pooled budget.

Systems to monitor patient flow

Featured pages