There are serious upsides to the NHS’s Discharge to Assess (D2A) approach to hospitalisations, and it’s not simply because no-one really wants to be in hospital as a patient. Despite this, experience tells us that there can sometimes be apprehension about actually leaving the hospital – especially when we’re thinking about a loved one. After all, isn’t hospital the best place to get specialist medical help fast?
But D2A really does support recovery, and it’s not something you need to worry about.
Before we explore the benefits of D2A, let’s clear up any confusion about what D2A is and isn’t.
Firstly, D2A is an approach to managing the way that people are discharged from hospitals and assessed to ascertain what sort of support they need.
In the past, hospital staff assessed the support needs that a person would have after being discharged, set that up, and then only discharge the person. This led to longer hospital stays, and it was later found that a better and more efficient approach is to discharge a person before their recovery support needs are assessed.
This is done by placing a person on one of four pathways according to the estimated recovery needs that a person has:
It’s important to note that you will NEVER be discharged under D2A if you are not ready to be discharged. You will only be discharged when you are well enough to be discharged AND there is no clear indication that your condition will deteriorate.
One thing we know for certain is that recovery is a wholistic endeavour. You have to think beyond the mere treatment of physical symptoms, injuries and illnesses that a hospital provides.
One of the ways that D2A contributes to a wholistic approach to recovery is in the way it promotes your wellbeing.
Staying in a hospital can bring about a sense of disorientation and lead to you feeling as though you’re a passenger in your own life. Your routines are controlled and you constantly defer to medical authorities while in hospital. Added to the fact that you are not making any of your own choices, because you’re in an artificial environment, the world tends to feel like it is drifting past and you can find yourself feeling foggy and losing grip on normal life.
Earlier discharges obviously help prevent this because it gets you out of the hospital which automatically puts you back in the driving seat of your own life and gets you back to the familiar surroundings of home.
This is good for your emotional wellbeing. Not only does an earlier discharge reduce the stress and anxiety that is part and parcel of being in hospital, but it also brings you the very real comfort of home.
There’s a reason they say there’s “no place like home”.
But apart from the general emotional comfort that coming home from hospital brings, the ability to get back to familiar hobbies, creature comforts and socialising (within the temporary restrictions of your health situation, of course) also makes you feel more human.
If that isn’t benefit enough, what about the unparalleled effect that getting back together with family brings?
One of the most powerful things for recovery is having a feeling of agency or independence, and even though the hospital to home transition under Pathways 1-3 come with slight changes to your care and support needs, the fact that you’re leaving hospital means that you have to take a more active role in your recovery.
Once you leave the hospital (with the potential exception of pathway 3), you’re taking an unmistakable “next step” as well as gaining more agency because you end up in an environment where more is required of you.
When you consider that 95% of people leaving hospitals are on D2A pathways 0 and 1, this effect becomes all the more powerful because it means that those people will be returning home sooner, ready to get back into routines they control, leave the house when they want to, get involved in community events, and socialise when and where they want to.
All of that is deeply empowering and promotes the recovery process in a way that being largely passive in a hospital room cannot.
The staff at hospitals are fantastic, but that doesn’t mean that there aren’t risks and drawbacks to hospital stays.
If you’re an older adult, hospital delirium, physical decline and mobility impairment are all risks in hospital stays – especially prolonged hospital stays. The physical and cognitive risks are particularly linked to a sense of agency and physical exercise, both things that hospital stays hinder.
Of course, the same is true for people in their prime, just to a lesser extent.
The big risk, though, is the risk of hospital acquired infections. They’re on the rise, and they’re increasingly drug-resistant. Getting one of these infections is unpleasant, to say the least, when you’re in your prime, but they can be seriously damaging to older adults. When you consider that everyone who is receiving treatment in a hospital is – to a greater or lesser degree – not in stage of peak health, you can see why getting out sooner is better.
Perhaps the most important benefit (though we’re open to a different ranking) is the way that D2A home care just provides better support.
This works in two ways:
On the D2A approach, the support assessments tend to be more accurate because they don’t take place in the hospital. This might seem counter-intuitive to you, but because the assessment is carried out at home, there are inherently more sensitive to your actual needs and your home situation, and, therefore, they become more accurate.
Remember, the point of the assessment is to figure out that what temporary support you need to aid your recovery. This can be obscured in the hospital.
At home, however, the kind of home care you need from a professional caregiver (or other health professional) becomes obvious fast, and you can get the help you need.
On a related note, because you’re the only one at home, when your caregiver comes around for the daily visit (or whatever the care programme looks like – that’s actually another benefit: it’s truly tailored to fit your situation), all their attention is on you, not the next bed. This means that they are able to identify problems or potential problems or simply suggest adjustments to the care plan as your recovery improves.
Both of these things are tremendously powerful in supporting your recovery.
Whether it’s reducing the risks associated with hospital stays and enabling more accurate assessments, D2A creates a safer recovery environment. Added to that, when you get the right D2A home care, you also get the best assessments and highest standard of support that brings the best possible support for your recovery, while also allowing you to get back to truly living in an independent, meaningful way.
Having said all of that, we know that the D2A approach – especially in its practicalities – can seem complicated at first. Why not get hold of us? We have a dedicated D2A service and understand the system completely. We’d be happy to help you, even if it’s just to understand the procedure a bit more.
Pathway 0 simply means that you don’t need any extra help. On this pathway, your hospital care team have looked at you and determined that you don’t actually need an assessment. You simply go home and get back to living your life. That’s actually part of why we like this approach so much and say that it’s good for your recovery. If you go onto Pathway 0, you get all the independence and emotional benefits of being discharged, as well as avoid any extra risks that come with prolonged hospital stays. The sooner you get back to your normal life, the better.
That depends on your pathway.
No. The NHS-funded D2A service covers four weeks (sometimes it can be extended to six weeks) of rehabilitation, reablement and care. Private D2A services are not paid for by the state, and work alongside the funded period or after it to fill the gaps and add extra cover that the NHS doesn’t provide to ensure that your loved one gets the care that they need. A private D2A service sits alongside or after that funded window. We work alongside and in partnership with the local council as a critical service provider to the NHS.
Our service is limited to the areas in which we have offices, namely Bedfordshire, Gloucestershire, Hertfordshire, Northamptonshire and Oxfordshire.
Nevertheless, we are happy to take your calls if you are outside those areas to provide advice so you can move in the right direction to get the help you need.
We're here to support you every step of the way. Whether you have questions about our services or need assistance in finding the right care for your loved one, our compassionate team is ready to help.
We understand that this journey can be challenging and we're committed to providing you with the information and support you need.
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