How social workers can support safe hospital discharge

Covid 19 meant many social workers lost their identity and role in ensuring safe hospital discharge for people, Richard Brown, Manager for Hospital Social Work Services and First Response in Hounslow Borough Council, said.

‘Overnight, Covid 19 brought a sea change in the ways in which people are discharged from hospital,’ he said. ‘It became about getting people home quickly. People had to be discharged without assessment and everyone went home or into nursing homes and placements. We have seen that the Covid enquiry has identified that bad decisions were taken. We understand why but when it was used across the board, it was very dangerous.’

‘It is not why people signed up to social work and we lost a bit of our identity in that process.’

Since September 2022, Hounslow taken back control of the service – he said that one social worker on the team said she felt she had got her job back.

‘We do work quickly so speed is key but it is not the only driver of performance. We began using the Care Act again on the wards. We meet the people and talk to them and get to know them. Under D2A [discharge to assess], some of those conversations weren’t happening and people were being discharged from a piece of paper saying “Joe Bloggs needs this”.

‘We all know a piece of paper rarely reflects the reality in front of you. Now no-one leaves he hospital without us seeing them physically. We see the family, and others involved ….my team are now on-site doing care assessments on the wards and in Hounslow we are big believers that will be the best way to achieve positive outcomes for our residents.

‘Where it is very straightforward and simple, we can discharge and assess a person in the community. However, people have a right to an assessment in hospital.

‘We are supporters of “Hospital At Home”, where it is used properly and not just to create capacity.
That said, we do need to know why the NHS is so keen to free up capacity – a study by the Royal College of Emergency Medicine last year said that 14,000 people died needlessly while waiting for up to 12 hours in A/E. So we do have a role in supporting the hospital and we have to work with them in that.’

His colleague, social worker Rosie Kirsty Richards described her work in assessing people for discharge. ‘The social worker’s identity is a big issue here. What I have found is that I have the statutory knowledge and skill to be able to uphold and promote the rights of the person in this transition.

‘You are the one saying when discharge is not the right place for this person or that a person is at risk of becoming institutionalised because they have not built up their skills around, say, cooking, so will collapse and need to be readmitted.

‘It’s about making everything as slow and gentle, empowering the person and making sure they are as independent as possible. That is where the social worker’s identity sits.

‘My initial assessment is around 45 minutes,’ She said it was a conversation, ‘finding out about their story, their background. My role is to understand as much about them as possible, for example finding out why they have anxiety about leaving the house. If you go in and fire a list of questions like, can you dress yourself? Can you use a toilet? They will just go “you are really annoying, leave me alone.”

‘If you come in and say “I’m here to support you in your journey from being in hospital to being in the community, what is it that you want me to know and what is it that you want me to help you with?” That way you are going to build trust.’