Senedd Committee recommends changes to hospital discharge guidance following evidence from Care & Repair

Care & Repair provided evidence to the Local Government and Housing Committee’s inquiry into the role Local Authorities play in hospital discharge. We spoke about the importance of third sector organisations in picking up work that local authorities cannot easily complete, such as small home adaptations essential for safe hospital discharge.

Hospital to a Healthier Home has been delivered by Care & Repair across 17 hospitals in Wales since 2019. Our specialist caseworkers work with patients and hospital staff to identify older patients who are well enough to go home but cannot because of a problem with their home. Last year the service supported over 3,800 patients to go home more quickly by completing nearly 7,500 home improvements.

We spoke about the speed of the service and our ability to solve problems but said patient experience could be improved if housing conditions and accessibility requirements are considered earlier in the discharge planning process as routine. The current hospital discharge guidance mentions home adaptations but omits housing conditions.

Through our service, we have received referrals for patients who have no heating or hot water being discharged the same day, instances where large repairs are needed to make the home safe and habitable, or where the home needs deep cleaning to allow for a package of care.

In our oral evidence we said:

“There is increasingly a policy emphasis on care closer to home. If that’s the direction of travel, then we really do need to also be thinking about the home that that care is going to take place in” – Faye Patton, Head of Policy & Insights at Care & Repair Cymru.

Following our evidence, the committee has recommended:

Recommendation 12 The Welsh Government should amend hospital discharge guidance to ensure that housing is included as a named partner agency and that a person’s housing condition is fully considered and planned for during discharge

We also spoke about the impact of Hospital to a Healthier Home on patient flow. Nationally, the service saves the Welsh NHS around 25,000 bed days each year. Locally, the service has a strong reputation for providing quick solutions in each hospital, and is heavily relied on by multi-disciplinary teams, particularly Occupational Therapists. Despite these strengths, in some areas of Wales the service still receives annual funding, with decisions made late in the day for the following year. We described the challenges we face around capacity and loss of skilled staff. The committee said:

Recommendation 13 The Welsh Government should work with local authorities, local health boards and the third sector to establish a strategic approach to hospital to home services. This should include exploring how to improve commissioning, with longer-term funding for proven hospital to home services, and how it can reduce waiting lists for the Disabled Facilities Grant.

We are pleased to see the role of the third sector recognised in the committee report, especially as the inquiry began only considering the role of local authorities in hospital discharge. This shows the vital role the third sector plays in supporting statutory services and providing agile, flexible services to support patients leave hospital safely and quickly.