Principle 5: Encourage a supported ‘Home First’ approach

Take a ‘Home First’ approach, providing patients with support at home or intermediate care. Wherever possible, patients should also be supported to return to their home for assessment. Evidence available on local.gov.uk and reducingdtoc.com websites suggests that this can help with the over-prescription of care, which often happens when patient assessments are undertaken in hospital.

Implementing a Discharge to Assess Model (D2A) where going home is the default pathway (with alternative pathways for people who cannot go straight home) is more than good practice – it is the right thing to do.

Staying in hospital for longer than necessary has a negative impact on patient outcomes. Ensuring that patients are given the chance to continue their lives at home is vital for their long-term wellbeing outcomes.

There is no ‘one size fits all’ model that will deliver D2A. What is required can be described as a ‘complex adaptive system’ which involves simple rules, rather than rigid inflexible criteria.

However, there are some core principles that you should follow when establishing a model in your area:

  • D2A should be free at the point of delivery, regardless of ongoing funding arrangements.
  • For the patient’s safety, the assessment should be done promptly (within 2 hours of arriving home), with rapid (on the day) access to care and support if it is required.
  • Ongoing support services should be time-limited to up to 6 weeks. In the best systems the average tends to be 2 weeks and is longer than 6 weeks only in exceptional cases.
  • D2A should be a non-selective service that tries to always say ‘yes’ – including support for end-of-life care.

To get started, use Plan, Do, Study, Act (PDSA) cycles to test new ideas rapidly, monitor closely, learn and develop. Starting small and growing is more effective and achievable than trying to change the entire system all at once.

There are also some excellent examples from around the country of how different hospitals and the social care partners have implemented this.

Links to further resources