Report to : Overview and Scrutiny Committee
Subject
: Discharge in HPT
Report by : Jonathan Wells (Practice Governance Lead – Mental
Health)
Date :
8th February 2006
1. Introduction.
This report has been prepared in order to provide more information to the Committee
about progress in HPT around discharge arrangements for service users, as requested
by the Committee.
This forms part of the overall scrutiny and monitoring of the Trust’s performance against
Standards for Better Health, carried out by the OSC as representative of key partners to
NHS Trusts.
2. Background.
Standard C6 of Standards for Better Health is as follows:
“Healthcare organisations co-operate with each other and social care organisations to
ensure that patients’ individual needs are properly managed and met”.
This is the main standard against which our improvements in discharge arrangements
are described in the Annual Health Check, although evidence relevant to good
discharge planning is also included under the “Safety” and “Patient Focus” domains.
We have declared ourselves compliant with Standard C6, and the evidence for this that
relates particularly to discharge is summarised below.
3. Improvements in Discharge Planning.
In Mental Health Services when service users are discharged from hospital into the
community, good discharge planning is vital. Whilst it is also important for Mental Health
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Services to be clear about how service users are discharged from services as a whole,
hospital discharge remains a particular focus of attention.
Significant initiatives in the past year include the following:
 Discharge arrangements are made using the Care Programme Approach, which
is designed to ensure good co-ordination between all agencies, a balance
between health and social care aspects of the service , and active involvement of
service users and carers themselves. Different aspects of the CPA are audited
each year, and the 05/06 audit, ( yet to report), examines our performance in
terms of service users having copies of their own care plan. The National Patient
Survey 2005 had shown that there was room for improvement in this area , so
that this has been a priority for managers at all levels in the past 6 months.
 Integrated services are essential for good discharge planning. Integrated
Specialist Mental Health Teams for Older People (SMHTOPs) were established
in April 2005, joining the integrated Community Mental health Teams (CMHTs),
Crisis Assessment and Treatment Teams (CATTs), and Assertive Outreach
Teams (AOTs). In the past year new Operational Policies have been agreed for
CMHTs, SMHTOPs and for Acute Inpatient Units, spelling out the mutual
responsibilities of these different core elements of the service, and giving clear
messages to staff about how inpatient and community services work together.
 One critical area of discharge planning is the identification of “high risk”
inpatients, and their follow-up in the community within 7 days. HPT’s
performance against this target of 100% is as follows:
2005/2006
Quarter 1: 72%
Quarter 2: 75%
Quarter 3: 78%
December 2005: 81%
This upward trend is encouraging but still leaves room for improvement.


7 day follow- up has also been made a priority for audit. The audit in October
2005 found that compliance with our standards was good, with 100% of cases
that met the criteria for 7day follow-up having a discharge planning meeting, and
all cases except one being followed up by the care co-ordinator within 7 days of
discharge. This showed a marked improvement on the last audit’s findings which
were that only 53% cases met the necessary criteria.
Good discharge is also about avoiding delayed transfers of care, and keeping to
a minimum the numbers of service users who remain as inpatients when this is
no longer necessary. Especially on older people’s inpatient units, these figures
are regularly reported and closely monitored, with joint arrangements being in
place between HPT and ACS to minimise the numbers.
The Operational Policies mentioned above ( Acute Inpatient Care, CMHTs, and
SMHTOPs), describe clear arrangements for the admission, transfer and
discharge of service users. Because they are organised around the Care
Programme Approach, ( and the Single Assessment Process (SAP) for older
people with mental health problems but without complex needs), they delineate
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integrated care pathways for service users. This means that discharge planning
is now better organised, with greater clarity of role, and less need for extra
referrals and re-assessments within the mental health system.
4. Concluding remarks.
As well as the features described above, there have been other practical initiatives in
the past year to improve discharge planning. For example, the County Acute Care
Forum has introduced a standard discharge checklist now used on all acute inpatient
units, to ensure that the named nurse for each inpatient carries out their tasks
comprehensively and in a way that can be easily checked by ward managers. There
have also been local initiatives, such as in North Herts and Stevenage where a regular
meeting has been set up involving the local CMHT manager and modern matron in
order to address any issues promptly and strengthen working relationships.
Discharge from inpatient to community care remains a critical area for any mental
health service, with rapid decisions needing to be made about risk, and about how
complex health and social care needs can best be met, potentially via many services
both within and outside HPT, and with the active involvement of service users and their
carers themselves.
In the coming year, with fewer inpatient beds and increased pressures on community
services, discharge planning will need to be of the highest quality. The improvements
outlined above will need to be maintained, and their impacts monitored in a variety of
ways, including quantitatively as Performance Indicators, and qualitatively through audit.
Jonathan Wells
Practice Governance Lead (Mental Health)
8 February 2006
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