Granted this is not the most exciting of reading, but essential for anyone who may:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts"> find themselves, or a member of their family in a NHS (England) hospital from 1st September

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">be responsible for supporting discharge

(Thread) https://www.gov.uk/government/collections/hospital-discharge-service-guidance">https://www.gov.uk/governmen...
Hospital discharge service guidance

Guidance on how health and care systems should support the safe and timely discharge of people who no longer need to stay in hospital.

https://www.gov.uk/government/collections/hospital-discharge-service-guidance
Few things to note in this:

Emphasis is heavily on rapid discharge & community assessment: moves most assessment post acute care into communities-piling pressure onto local authorities & CCGs

Free support available on discharge up to 6 weeks https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
The 6 week cut off in communities will become the new point of critical failure in system flow while agreements are reached about who

For people with complex needs this has been a historic battle ground of dispute and delay with inadequate CHC assessment capacity https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
Guidance about COVID screening prior to care home entry doesn’t make sense for care homes unable to support safe isolation

LA must find an alternative place of care curious as to what DHSC means by this

Don’t think hotels/hostels will cut it for people needing complex care https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
All of this moves attention away from hospitals towards the more diffuse & difficult to ‘manage’ world of communities

It also has potential to shunt cost and dispute about care into already inadequately resourced parts of the system leaving CCGs and LAs to go figure https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
This deeply concerning for people with complex care needs those with significant functional & cognitive needs & their families

None of it recognises that shifting boundaries without substantial new resourcing will do anything useful to fix historic problems with long term care
Meanwhile the new ‘criteria to reside’ assessed twice daily will become the new hospital mantra

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
The Criteria to Reside are heavily skewed towards critical & procedural care-yet the majority of people needing longer stays in hospital do not get anywhere near critical care or procedures

Mostly they are older with acute frailty syndromes where things are much less cut & dried
If nothing else- rigidly enforced & performance managed Criteria to Reside could drive older people & those with complex conditions, especially delirium into their communities having been inadequately assessed

This winter we need to look out carefully for rising NHS readmissions
Data collection/performance management of the Criteria to Reside will be on a par with the ED 4 hour data industry

How good are your electronic data systems? Most hospital EPR & patient administrative data systems will struggle with the daily data requirements set out herehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
Make no mistake-there WILL be considerable centralised performance management for hospitals and systems of the new Discharge Guidancehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
Delving deeper into this I’m wondering where the discharge funding ‘Government has agreed’ is going to come from https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">

It’s pretty obvious that some of the original @AgeingWellNHS programme which was a #NHSLongTermPlan commitment just over a year ago has been recycled into this https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">
Delving deeper into this I’m wondering where the discharge funding ‘Government has agreed’ is going to come from https://abs.twimg.com/emoji/v2/... draggable=It’s pretty obvious that some of the original @AgeingWellNHS programme which was a #NHSLongTermPlan commitment just over a year ago has been recycled into this https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">" title="Delving deeper into this I’m wondering where the discharge funding ‘Government has agreed’ is going to come from https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">It’s pretty obvious that some of the original @AgeingWellNHS programme which was a #NHSLongTermPlan commitment just over a year ago has been recycled into this https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">" class="img-responsive" style="max-width:100%;"/>
And what now for the Better Care Fund which appears to be parked in planning terms but @NHSEngland has been keen to redeploy even as we developed the #nhslongtermplan?https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">

https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/">https://www.england.nhs.uk/ourwork/p...
@threadreaderapp unroll
As a post script to this the new Who Pays guidance covering commissioning responsibilities in England is an even more challenging read. The most important parts are however set out in para 14 https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">

https://www.england.nhs.uk/wp-content/uploads/2020/08/Who-Pays-final-24082020-v2.pdf">https://www.england.nhs.uk/wp-conten...
Helpfully this does clarify some historically disputed issues relating to CCG responsibilities

In the main these revert to the CCG in which sits the GP with whom a patient was registered at the start of an episode

So far so good then.. (there’s a BUT coming..)
BUT in March 2020 @NHSEngland instructed hospitals to free hospital capacity to deal with the COVID pandemic

In the scramble some patients may have ended up in care homes out of area

There’s a balanced review this in the following long readhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">

https://nhsproviders.org/media/689544/spotlight-on-recent-nhs-discharges-into-care-homes.pdf">https://nhsproviders.org/media/689...
There were already significant CHC eligibility assessment & review backlogs in England prior to COVID

With ongoing sporadic lockdowns & restrictions on care homes visiting, assessment of CHC eligibility is likely to be even more challenging https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten"> https://caretobedifferent.co.uk/key-areas-of-concern-for-those-in-need-of-chc-funding/">https://caretobedifferent.co.uk/key-areas...
COVID: How Will Backlogs Impact on NHS Continuing Healthcare Funding? - Care to be Different

Whilst care providers still have restrictions in place to deter visitors and protect their vulnerable residents, it is inevitable that in time, those restrictions will continue to ease slowly....

https://caretobedifferent.co.uk/key-areas-of-concern-for-those-in-need-of-chc-funding/
While the backlog for standard Continuing Health Care eligibility assessment had fallen over the last year, as we entered the first phase of the pandemic it was starting to go up again

By end of Q3 2019/20 ~1850 were waiting with 70% waiting >2 weeks

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/02/CHC-and-FNC-Report-Q3-2019-20_z5qnTp.pdf">https://www.england.nhs.uk/statistic...
Under the Who Pays @NHSEngland guidance payment responsibilities now revert from the CCG where a residential care provider is based (the March 2020 guidance) to the CCG responsible for care at the point of hospital discharge:
There are a few big issues for CCGs here:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Historic and new CHC assessment backlogs

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">COVID care home visitor restrictions

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts"> 1st Sept discharge guidance rules

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Non-COVID hospital demand is already rising

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">A hard cut off for clearing backlog and disputes by 31st December
You can follow @runnermandoc.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled:
There are a lot of misconceptions about the Turkish diaspora in Germany. Since i just finished writing an essay about this topic I thought it's time to give other people
Read more
Las mejores calculadoras online en 2020A thread http://totumat.com/2020/11/26/las-mejores-calculadoras-online-en-2020/ Cuando se estudian asignaturas que requieren de cálculos complicados, nada mejor que contar con una buena calculadora.
Read more
Mitigating #ClimateChange is as much about taking up new techs as about leaving others behindMost studies focus on #coal's global downfall but another #energy tech decline is loomingRead my new
Read more