The Health and Social Care Secretary, The Rt Hon Sajid Javid MP- recently published new proposals to build a modern health and care system, one that delivers better care for our communities.

These proposals are being introduced in Parliament on 06 July 2021. The blueprint for this was shared earlier in the year (11 February, 2021) when the Department of Health and Social Care published the legislative proposals for a Health and Care Bill.

The Health and Care Bill builds on the proposals for legislative change set out by NHS England in its Long-Term Plan, whilst also incorporating valuable lessons learnt from the pandemic that will benefit people using services, patients, and staff.  Amongst the key measures outlined, the one relating to Hospital Discharges are:

  • The NHS and local government coming together to plan health and care services around their patients’ needs, quickly implementing innovative solutions to problems which would normally take years to fix - including moving services out of hospitals and into the community, focusing on preventative healthcare.
  • A package of measures to deliver on specific needs in the social care sector. This will improve oversight and accountability in the delivery of services through new assurance and data sharing measures in social care, update the legal framework to enable person-centered models of hospital discharge, and introduce improved powers for the Secretary of State to directly make payments to adult social care providers where required.

The Hospital discharge service: policy and operating model Guidance updated in February 2021 by the Department of Health and Social Care required both the Health and Social Care Economies to work together to ensure the discharge of patients from hospital that should lead to a significant change from previous arrangements. The new policy, Discharge to Assess or D2A, was nationally mandated in March 2020 to ensure that discharges can happen as smoothly as possible. It proposed to remove legislative barriers to the D2A.

The D2A approach was already adopted in some areas pre-pandemic and has been nationally funded since March 2020.  This policy guidance stated that the assessments of people for their longer-term care and support needs should take place after they have had a period of recovery (and not in the hospital). Essentially it asked systems to stop bed rest in hospitals.

It contained all that the Health and Social care sector knew about good practice which was inconsistently implemented prior to this point. It highlighted that there are wider barriers to effective discharge and the cost of delays, and caring for citizens in other settings, were and still aren’t well understood. The D2A model enables local areas to adopt discharge processes that best meet local needs.

Up until the implementation of D2A policy, some systems were assessing to discharge, causing significant delays. In order to achieve the aims of D2A most systems will require a shift of assessment and therapy staff from the acute hospital to the community, so that these assessments are undertaken at the optimum time. It will also require an investment in intermediate care services in both bed-based care and the community. It will be interesting to see how the new legislation and upcoming ICS developments will further strengthen the partnership working with Health/Social and Voluntary sector around Hospital Discharges and out of hospital care.  

Let’s hope that new Social Care Bill proposals address the range of factors that are still impacting on the ability of local systems to work together and discharge effectively. The government is committed to delivering world-class care for patients, and this Bill will help to deliver it, building on the NHS’ own proposals for reform to make it less bureaucratic, more accountable, and more integrated in the wake of COVID-19.

We know that some hospitals have financial incentives to minimise the length of stay for emergency attendances and keep space free for elective procedures for patients. However, community health providers and local authorities are not incentivised financially to speed up receiving patients discharged from hospital; and some systems lack integrated discharge and out of hospital pathways. This needs to be fundamentally re-explored to make in any improvements in an area of such huge interest to people who use services and to all in NHS and local government.

I welcome the ambitions and aspirations outlined in the Bill; it gives clearer accountability for the NHS and at a system-level formalises shared governance across the NHS, local government, and other partners. The proposals will support greater collective effort on improving outcomes for those of us who need care and support, which is the ultimate purpose of our collective efforts in supporting hospital discharges.


Balwinder Kaur, Assistant Director

Executive Lead for Hospitals and Out of hospital pathways- Birmingham City Council