A Digital Approach to Discharge to Assess
To develop a digital Discharge to Assess (D2A) platform that can be used to support a safe and timely discharge from acute hospitals to community health and social care.
This programme of work brings together local authorities to co-design a supplier agnostic, cloud based solution to the D2A challenge. Developed by an experienced technical provider, council partners will support the co-design of a minimum viable product. The platform will be a technical enabler for a Discharge to Assess model, to ensure hospital discharges are efficient and safe. The solution will enable accurate and timely information to be made available to better manage a person’s transition of care from hospital to home or care setting.
Work on the project began in early July with an all partner discovery workshop and subsequent requirements scoping.
The challenge of tracking patients from hospital to home is a national issue reliant on gathering information from separate services and organisations in the acute and social care setting, causing a delay in the availability of reliable information. This issue has been intensified during COVID-19, when there has been an increase in hospital discharges and the requirement for Adult Social Care to support Discharge to Assess.
Sharing of key information to support hospital discharges is over-reliant on spreadsheets, emailing information back and forth or numerous telephone calls, which is not sustainable in the medium and longer term. Equally, manual spreadsheet trackers and email suffer from significant duplication, risk of error and can’t offer a single version of the truth.
The D2A platform will digitise the processes and overcome these inefficiencies. The solution design will enable a multi-tenanted approach, where allocation and notification can be undertaken by different parties based on a set of agreed business rules (e.g. location) and authenticated permissions.
Maldaba works with public sector bodies and not-for-profit organisations to deliver innovative solutions to complex problems. Since 2002, they have applied their expertise in strategic design, research and product development to deliver award-winning solutions, which are both scalable and offer measurable benefits in terms of digital transformation.
The main benefit of a digital D2A approach is that it would enable a fully effective Discharge to Assess operating model, with the following expected associated benefits (which will be measured where possible as part of the programme of the project):
- Reduce the risk of patients leaving hospital without care and support needs being in place
- Empower staff within the multi-disciplinary teams (MDTs) working on specific community-based pathways with access to accurate, up-to-date and timely information they need, from any location, to remotely manage the allocation and access to adult social care services – allowing them to make the best decisions for the patient
- To create a solution that enables alerts to all professionals aligned with the individual’s transition of care
- Reduce the risk of hospital readmissions
- Improve the quality and timeliness of the needs assessment at the point of discharge
- Eliminate significant manual input and duplication and time delay to free up resources
- Deliver a scalable solution which can develop and realise NHS Digital Pathfinder and Professional Records Standards Body (PRSB) standards and economies of scale
- Offer a rich source of data across health and social care enabling new analytics capability, providing enhanced insights and improvements in service and support
- Reducing the gaps in the process where issues or lack of oversight or clarity can arise
Areas of savings and efficiencies have been identified as follows:
- Reduction in failed discharges and readmissions
- Administration cost savings
- Reductions in the number of business support staff currently employed across the local authority and partner organisations to manually manage the trackers – allowing them to be better deployed elsewhere
- Reduction in delays in assessments, moving people from expensive community placements to their own homes at the right time
- Management time and operational savings through elimination of multiple phone calls
- Potential financial savings for both social care and acute settings on the basis that clients would be more efficiently discharged and managed
- The additional cost of remediating cases where people have been lost in the system, understood to be between 15% and 25%
- Support commissioning needs and reduce costs of commissioning services that do not support flow
All of these savings will be thoroughly examined as a part of the project to help build the longer term business case for wider takeup across the sector.
From a health perspective it is calculated that a delayed transfer of care (DToC) will cost £400 per day, per bed and so a modest reduction of 20 DToC days per month will equate to savings in the range of £100,000 per year.
NB: These milestones and dates are subject to change due to the collaborative, co-design and agile design/development approach of the project and based on the agreement of the participating partners.
We recognise timescales for deployment may need to be led by each Local Authority and will take into consideration Winter pressures.
PROJECT FUNDING & APPROACH
Each council partner has financially contributed to the project in addition to match funding provided by NHS Digital, via the Local Government Association’s Social Care Digital Innovation Accelerator. This collaborative approach both in funding and design, means that the resulting solution will meet the widest set of partner requirements.
All development will be undertaken by the delivery partner, however co-funding partners will support and steer the solution via active, remote co-design. Bringing subject matter expertise to the table (the focus of which may change over time), partners will help define and prioritise features and work packages, plus support user testing and deployment.
It is noted that NHS Trusts will be key partners in this project as such the collaborating councils will engage and involve their health partners in the co-design process where appropriate.
Partners will also contribute to modelling the license fee to ensure a sustainable and equitable approach to pricing.
This project is being independently assessed by the Institute of Public Care.
KEEP UP TO DATE
As this project progresses there will be updates, webinars, reports and business cases all of which will be freely available to councils across the UK. The key of all the SCDIA projects is to make best use of public funds and scale the solutions to other councils once developed. As such we are keen to engage with councils around the D2A. So if this is a project you would like to know more about or if you or a colleague would value a discussion about the work to date, please get in touch.