1. Understanding Our Delayed Discharge Problem

2. Overall Performance

3. Overall Performance

4. How do we compare?
Delayed discharge bed rate per 1,000 population; 2015/16

5. How do we compare?

6. Front door

7. Action Plan: Preventing Admission
Ensure that SPARRA (Scottish Patients At Risk of Readmission and Admission) data is disseminated via dashboards and used by all primary care teams
Anticipatory Care Plans become more widely used, especially for people with Long Term Conditions or who have palliative care needs
Ensure that A&E and assessment staff have up to date information about care options, support and transport, including rapid response and Out of Hours options
Work with nursing and medical staff on a policy of 'decide to admit' rather than 'admit to decide'

8. Assessment Process

9. Care Home Occupancy

10. Our Code 9 problem
Average number of delayed discharges across all census points; 2015/16
Code 9 was introduced in July 2006, following discussions between ISD, the Scottish Government, health and local authority partners. Several conditions were agreed to be applied to the collection and presentation of delayed discharge data. This code was introduced for very limited circumstances where NHS Chief Executives and local authority Directors of Social Work (or their nominated representatives) could explain why the discharge of patients was out with their control. These would include patients delayed due to awaiting place availability in a high level needs’ specialist facility where no facilities exist and where an interim option is not appropriate, patients for whom an interim move is deemed unreasonable or where an adult may lack capacity under adults with incapacity legislation.

11. Action Plan: Assessment
More effective use of Estimated Date of Discharge and escalation processes
A presumption in favour of assessment at home will be implemented, linking with wider reforms around early supported discharge
Light-touch early assessment by MDT devised to support discharge planning, with defined timelines
Plans will be put in place to optimise the activity of patients in the hospital, to ensure physical independence is maintained
Pre-existing care packages are kept open until such times as a full assessment has been done, subsequent to reablement process

12. Length of stay in care homes

14. Action Plan: Discharge
Arrangements are put in place to increase the number of weekend discharges
Criteria-led discharge to continue to be developed
Transportation options are clearly understood by all staff involved in the discharge process
The early supported discharge team is augmented with home care coordination and assessment and care management capacity to deliver a multi-disciplinary approach
A blue print is developed for bed based intermediate care in Stornoway
Flexible recruitment of homecare workers and healthcare assistants for deployment in different settings