CC2i & Partners
Digital Discharge to Assess (Hospital to Home)
Briefly describe the initiative/ project/service; please include your aims and objectives
The challenge of safely discharging people from hospital is a national issue reliant on gathering and continually sharing/updating information from separate, unconnected systems. It requires a multi-agency approach involving hospitals(ward staff, doctors, discharge teams, pharmacy services et al), CCGs, adult social care teams, local authorities, transport providers, domiciliary care providers and others. Effective discharge from hospital is critical on so many levels and faces many challenges. Those that we know about in the public domain; budget pressures, the NHS being overstretched, an ageing population, ‘bed-blocking’, independence and ongoing health for people post a hospital stay – not to mention the challenges that Covid has brought over the last 12 months.
There is also a raft of administrative and organisational challenges that the public are unaware of. Regulatory and safeguarding procedures, medications provision, aligning transport from domiciliary care providers to social work teams to enable the safe discharge of people to their homes, unforeseen or unexpected last minute changes to the discharge process, the sheer number of people in hospital and who then subsequently need a social care assessment and support, as well as the additional Covid-related procedures and restrictions hospitals and partners now adhere to.
The updated Discharge to Assess (D2A) model was introduced in March 2020 in order to simplify and speed up hospital discharges in light of Covid-19. Since its introduction the team at North Lincolnshire Council -just like councils across the country – has been using all means possible to support the safe discharge of people, whether to their own home or a community hospital or care home.
The solution delivered several valuable benefits to the council and our residents, allowing better allocation of resources throughout challenging times. The streamlined approach and easy access to data for local reporting allowed mobile testing to be deployed at surge sites, helping to control and track the spread of the virus. But most importantly, the digital solution provided a better experience to members of the public whilst ensuring the sensitive demographic and medical data was securely held in line with GDPR. At its peak, we delivered over 1,000 tests across our centres each week – with 287 tests taken on our single busiest day. New testing centres were easily added to the booking system, and old centres were easily removed. The collaborative, agile development in partnership with NDL allowed us to quickly iterate through the changes imposed by government and improve the solution at each point. NDL were always available and regularly in contact to ensure the development of the booking system was on track and functioned as required. The use of MS Teams was a key communication tool with everyone working from home at the height of the pandemic. Benefits from further developing the solution, removing the basic booking webform and manual booking/email included;
• Improved employee morale
• Improved service and experience for residents
• Significant reduction in admin time and overheads
• Faster COVID-19 test bookings and recordings
• Local data aiding surge and hotspot testing
The active use of and response to localised data has been attributed to Wigan remaining in a lower level of restriction tier than neighbouring GM authorities during the summer of 2020 (local lockdown restrictions were removed from Wigan and Stockport on 20/08/20 and only reinstated on 25/09/20 in line with wider national directives). Thus, having a positive impact on the wellbeing of residents and socio-economic challenges associated with lockdowns. The project exceeded expectations, gaining recognition at a national government level along with other award ceremonies. Since sharing our story, other local authorities are making contact to find out what we did and how we did it.
Working through the pandemic has been challenging and with no single shared digital system we (health and social care partners) have had to rely on spreadsheets, telephone and emails to understand where in the D2A process each person is, and where and when they will require transport, domiciliary care, ongoing assessment and the ancillary services we provide. This complicated situation of managing the numbers of people at any one time has been exacerbated by team members working remotely. D2A is hugely time consuming, very labour-intensive and presents us with an ever-changing situation, where – there is no ‘single version of the truth’ or overview providing the ability to plan.
The aim of the ‘Digital Discharge to Assess (D2A)’ project was to develop a supplier agnostic, cloud based case management system allowing users (with appropriate permissions) to capture, update, track and report on data about a person’s D2Ajourney. The system would give a clear and comprehensive view across all current people on D2A pathways and a seven-day view of those that are to be discharged; the single version of the truth we all so desperately needed. Starting in August2020,five councils co-funded and co-designed a solution as part of the Social Care Digital Innovation Accelerator 2020/21(SCDIA),which was run by a public sector co-funding platform (CC2i) on behalf of the Local Government Association, and which benefited from NHS Digital match-funding. Subject matter experts from the five councils (North Lincolnshire, Southend, Sutton, Herefordshire & Birmingham) began by detailing our D2A challenges and then for the next six months were guided by the technical partner – Maldaba – who scoped, designed and developed a solution that met our varied – and quite complicated – requirements.
Critically the project encompassed both the technical and information governance elements of the D2A process, to allow the secure and appropriate sharing of peoples data and Hospital to Home (H2H) was successfully deployed in North Lincolnshire(and other partner sites) in February 2021. H2H offers case management and tracking functionality, allowing users from multiple organisations to create, update and track D2A cases through an open, human driven workflow. The platform supports the D2A process from the point at which a person is identified on the ward as requiring support on discharge, through to the point that the person receives an assessment on their longer term needs within a community setting. Within 24 hours of Hospital to Home being deployed in North Lincolnshire for trialing with our D2A team members, we had moved wholescale to the system and are already seeing significant time savings and benefits. Even at this early point – only a few weeks from the system going live – we are saving somewhere between 30% of administration time to manageD2As (approx 30 hours per week so far, with more expected). Wendy Lawty from North Lincs says, “Hospital to Home provides the one version of the truth. It’s really stimulated a different conversation. We’re having system conversations now because everyone can see the right information, at the right time, they can see progress.
What are the key achievements?
Hospital to home (H2H) – a platform that is used by health and social care to support the Discharge to Assess process in line with the Hospital Discharge and Community Support policy and operating model (HM Government). It was designed to bring order, improvement, and efficiency to the process of discharging patients from hospital and provides ‘one version of the truth’, with the ultimate aim of putting the person at the centre of decision making and improving their health and social care outcomes. Both social care and health have been involved in the development of H2H and continue to be engaged in its evolution, suggesting changes and tweaks to the system that would further enhance the discharge process. By using the H2Hsystem we have moved from different organisations using an often confusing array of different spreadsheets, to a clear, logical and mutually understandable system, where the most up to date information about the person can be seen instantly.
As the way in which people were discharged from hospital changed in line with Government policy, the H2H system has helped with the collaboration and partnership working between the health and social care teams – greatly improving and strengthening the relationships within the Integrated Discharge Team. H2H has assisted with the flow of patients in the hospital by ensuring that, during periods of extreme pressure, the operational managers within the hospital have been able to determine the finite number of beds that would potentially be available. The reporting suite, whilst still in its infancy in regards to its development and effectiveness, is nevertheless able to provide valuable data to inform and drive services.
The H2H system gives the social care and health teams an effective way of monitoring and working with people through their journey from being in hospital to their return home. Delays can be identified quickly and addressed which can lead to a more timely discharge, which is always the best outcome for the person. Themes and trends in delays or issues can be identified using H2H and in turn these can be the focus for improvement of the discharge process.
Typical Hospital To Home Savings are as follows:
– 30% Reduction of administration
– £24.68 Local authority administration saving per D2A
– 1 bed night saved every 2 D2As
– £200 Saving of Acute Bed provision per D2A
How innovative is your initiative?
The aim of the ‘Digital Discharge to Assess (D2A)’ project was to develop a supplier agnostic, cloud based case management system allowing users (with appropriate permissions) to capture, update, track and report on data about a person’s D2Ajourney. The system would give a clear and comprehensive view across all current people on D2A pathways and a seven-day view of those that are to be discharged; the single version of the truth we all so desperately needed. Starting in August2020, five councils co-funded and co-designed a solution as part of the Social Care Digital Innovation Accelerator 2020/21(SCDIA),which was run by a public sector co-funding platform (CC2i) on behalf of the Local Government Association, and which benefited from NHS Digital match-funding.
Subject matter experts from the five councils (North Lincolnshire, Southend, Sutton, Herefordshire & Birmingham) began by detailing our D2A challenges and then for the next six months were guided by the technical partner – Maldaba – who scoped, designed and developed a solution that met our varied – and quite complicated requirements. Critically the project encompassed both the technical and information governance elements of the D2A process, to allow the secure and appropriate sharing of peoples data and Hospital to Home (H2H) was successfully deployed in North Lincolnshire(and other partner sites) in February 2021. H2H offers case management and tracking functionality, allowing users from multiple organisations to create, update and track D2A cases through an open, human driven workflow. The platform supports the D2A process from the point at which a person is identified on the ward as requiring support on discharge, through to the point that the person receives an assessment on their longer term needs within a community setting.
What are the key learning points?
North Lincs took the first opportunity to adopt Hospital to Home and whilst the first release of H2H was a minimal viable product, by taking a proactive and positive approach, North Lincs have already realised significant benefits from the system. North Lincs are also well placed to influence the future development of the product and so a key learning is to take an agile approach to product development and implementation. By taking an agile approach, benefits can be realised earlier and customers can take an active role in the shaping of the future product, thus ensuring it will continue to be user centric, and deliver the best outcomes for North Lincs.An example of the above approach is North Lincs approach to H2H as a standalone product and as an integrated product. Inthe first phase, North Lincs went live with H2H as a standalone solution.
Once it was clear that H2H was delivering benefits to the D2A process, North Lincs have now commissioned work to integrate H2H with North Lincs and Google electronic patient record. Once this is delivered, it will bring further efficiencies to the process. The crucial learning point from this is that without taking a phased approach, North Lincs would not have unlocked the benefits already realised, and now there is a roadmap for future improvements which as they are delivered, will improve the process and allow North Lincs to maximise partnership working. During demonstrations of Hospital to Home, councils have expressed interest in extending the collaborative H2H platform to include those delivering intermediate care and the four associated pathways. By giving relevant professionals access to the ‘single source of truth’, it will extend the value already being realised by D2A partners, as well as extend improved management information and metrics to intermediate care. The approach to the extension of the H2H functionality will match the initial development in that there will be subject matter contribution from a mix of local authorities including North Lincs. A key learning from this project is the value in a diverse range of voices and opinions to help shape the requirements for the product. This ensures that benefits will be delivered to the maximum range of users and most importantly ensures a user centric, diverse approach to development.
