Questions for the CASCAIDr #HosDisChat 8pm 12 Dec

Please use the hashtag in every tweet (copy and paste for speed) and A1, A 4, A10 etc, to tie your thoughts to the relevant question. 

Advice on how to set up streams on your twitter tool is here:

For a stream for the whole chat, use #HosDisChat for the search instruction within Hootsuite:

For separate streams for each Q and A put this type of SEARCH instruction into a new stream that you can set up on eg hootsuite, for each of the 10 questions,

  • for Q1 and all the answers to Q1, excluding retweets,  enter: #HosDisChat AND (q1 OR a1) -RT


Fitness for hospital discharge and ‘clinical optimisation’ – who is accountable for these decisions?

Q1    Premature discharge is a breach of a duty of care, foreseeably likely to cause physical or mental harm to the person – and no doubt a serious incident and something that triggers the duty of candour. What stops that happening, in current discharge systems designed to get people out as fast as possible?

Q2    Does your local system actively consider NHS rehabilitation, NHS funded intermediate care and split packages of health and social care, before it considers checklisting someone for CHC and discharging those who don’t get positive checklists?


Options for integration of health and social work inputs, in the context of hospital discharge

Q3        Social workers in hospitals, used to be the norm – but an integration-based alternative is funding a social work, equipment, adaptations and homelessness rights service as part of a hospital’s system (or a joint ‘discharge to assess’ system) is  – is anything like that happening in your area?

Q4        Care Act functions can be delegated to NHS discharge staff – if they can be taught how public law works and trained to apply a carer blind approach and the Care Act criteria to an assessment. Why isn’t this being done as much as it could, do you think?


Checklisting for CHC – not mentioned in the Care Act’s hospital discharge schedule, and on its way out?

Q5    Does your local hospital discharge system checklist ALL its patients with complex needs, including self funders, or only the ones who’ve come to the attention of the local council, for assessment of a council funded placement or package?

Q6   What do you think of plans to raise the threshold for positive Checklisting, so that fewer people go on to get full MDT consideration of the mapping of their needs, as proposed by the Department of Health in a recent consultation here?


Choice rights, top-ups and arbitrarily low council/CCG rates for placements

Q7    What percentage of care homes in your area are now asking for top-ups before they will admit an elderly hospital discharge patient to a room, via a council placement? Does anyone know the difference between a top-up want and a need that’s just part of proper care planning?

Q8    What steps does your local council take to make a professional judgement on the suitability of available vacancies for the individual’s specific needs, before asking relatives to help the council decide, or consider paying a top-up?


Transparency regarding a home care offer, and cost-capping culture amongst councils and CCGs

Q9    Does the council or the hospital discharge social worker explicitly identify what would be funded at home, before offering a care home placement, or after any refusal to accept one by the patient or their family?

Q10    Is any home care package that might be offered to a person not wanting to go to a care home, capped, in policy or in practice to the council’s expected cost of placing the person in a care home, BEFORE the individual’s needs have been assessed under the Care Act?