TRUST POLICY AND PROCEDURES FOR THE DISCHARGE OF IN-PATIENTS

Transcription

1 TRUST POLICY AND PROCEDURES FOR THE DISCHARGE OF IN-PATIENTS Reference Number CL OP Version: 4.1 Status Final Author: Stephanie Marbrow Job Title Community Care Co-ordinator Version / Amendment History Version Date Author Reason 1 July 2005 S Marbrow Original Policy 2 July 2008 S. Marbrow Revised for NHSLA Sept -Nov 2008 Pam Twine Amendments following review 3 April 2009 S. Marbrow Amendments following MAC 4 April 2010 S. Marbrow Amalgamation of Carers Policy 4.1 November 2011 S. Marbrow Review required Intended Recipients: All staff involved with discharge planning for patients Training and Dissemination: Whilst the clinician is responsible for the patients discharge, nursing/midwifery staff co-ordinate the arrangements. All personnel discharging in-patients must have the knowledge, skills and competence to support a timely and safe discharge. Multi-agency programmes are available to support the wide range of disciplines involved in safe discharges. Information will be available via the Trust Intranet. To be read in conjunction with: The supporting discharge procedures available on the Trust Intranet, The Trust Transfer Policy, NHS and Community Care Act, Community Care Delayed Discharges Act, National Carers Strategy and Carers (Equal Opportunities) Act, Trust Policy and Procedures for Safeguarding Adults; Trust Policy for Safeguarding Children; Mental Capacity Act Policy and Staff Guidance; The Human Rights Act, Trust Policy and Procedures for Infection Control and supporting manual; National Policy Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, Medicines Management. In consultation with: Trust Discharge Group; Heads of Nursing (HONS) Joint Professionals Advisory Committee (JPAC); Medical Advisory Committee (MAC), Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page1

2 Local Authority Social Services Departments in Derby and Derbyshire EIRA stage One Completed Stage Two Completed Yes Procedural Documentation Review Group Assurance and Date Yes March 2012 Approving Body and Date Approved Clinical Effectiveness Committee Date of Issue March 2012 Review Date and Frequency Contact for Review Executive Lead Signature Approving Executive Signature November 2014 (then every 3 years) Community Care Co-ordinator Director of Patient Experience & Chief Nurse Director of Patient Experience & Chief Nurse Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page2

3 Contents Section Page 1 Introduction 5 2 Purpose and Outcomes 5 3 Definitions Used 5 4 Key Responsibilities/Duties Director of Nursing Community Care Co-ordinator Discharge Project Steering Group Care Co-ordinator Managers Individual Employees Multidisciplinary/Multi-agency Team Consultant Medical Staff/Designated Professionals Discharge Facilitators Kite Team 8 5 Managing the Policy and Procedures for the Discharge of In-Patients 5.1 Principles of Discharge Applicable to all Patient Groups Principles Applicable to Children and Young People Principles Applicable to Adult Patients Discharge of Adult Patients with Mental Health/Learning Disability Needs 5.5 Carers Documentation to Accompany the Patient Discharge Out of Hours 16 6 Monitoring Compliance and Effectiveness References Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page3

4 TRUST POLICY AND PROCEDURES FOR THE DISCHARGE OF IN-PATIENTS 1 Introduction This document is to ensure that Trust employees are aware of their responsibilities with respect to discharging in-patients from hospital. An abridged version detailing key points of discharge is available for patients and or carers Your Hospital Stay Planning for Discharge 2 Purpose and Outcomes It is the policy of this Trust to comply with current Department of Health policy and guidance, National Health Service Litigation Authority (NHSLA) standards, local standards and local joint agreements regarding all inpatient client groups, regardless of age, being discharged from hospital. This policy, is supported by the Discharge Operating Procedures (SOP) which aims to ensure all in-patients and their families/carers receive appropriate interventions towards a safe, efficient and timely discharge. This will be achieved by: Providing a safe, ordered discharge by ensuring that health and social care facilities are prepared to receive patients and carers. Ensuring that patients are discharged from hospital in a speedy and timely fashion to a safe and clinically-appropriate environment. Listening to carers needs and responding appropriately Providing information/medication/equipment to enable and foster independence for the patient/carer. Providing continuity of care through effective communications between hospital and community multi-disciplinary/multi-agency teams. Addressing discharge requirements specific to each patient group. The provision of appropriate documentation accompanying the patient upon discharge. Identifying the process for discharge out of hours. The policy applies to all staff directly or indirectly involved with discharge planning to ensure: Patients or their carers are involved in the discharge planning process and in deciding options for future care arrangements. Where appropriate a multi-disciplinary/multi-agency approach is taken with patients who have complex needs. 3 Definitions Used Discharge from Hospital The movement of any in-patient into primary care e.g. into the care of a General Practitioner or a mother and baby returning home into the care of a community midwife. Also included are adult Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page4

5 patients discharged to community hospitals or care homes. Patient Advocate Carer IMCA - Independent Mental Capacity Advocate Cared for person Discharge Plan Multidisciplinary/Multiagency Team Statutory Agency Telecare A person of any age regardless of diagnosis, attending the Trust for in-patient treatment/care. Someone speaking for/acting on behalf of another. A person or relative or friend providing care at whatever level to the relevant person Someone appointed to help adults, who lack mental capacity, to make important decisions where the patient is un-befriended. A person of any age who, due to ill health and or disability, receives care and support from either a paid or unpaid carer A Trust document used by the multi-disciplinary team in all wards, excluding Midwifery, identifying the process and procedures which will need to be completed, dependent on individual patient needs and circumstances, prior to discharge. A framework that brings together a range of health and social care professionals to enhance robust and appropriate discharge planning. Refers to Health, Social Care, Housing staff and Education Telecare is care and support from a distance, using information and communication technology to remotely, continuously and automatically monitor real time emergencies in the person s own home. 4 Key Responsibilities/Duties 4.1 Director of Patient Experience and Chief Nurse Executive lead who is accountable to the Trust Board for ensuring compliance with this policy in all parts of the Trust. Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page5

6 4.2 Community Care Co- ordinator To interpret Department of Health policy, guidance and circulars in order to advise the Trust of its statutory responsibilities regarding discharge from hospital. Responsible for the co-ordination and distribution of the Discharge Policy and supporting information/documentation and, to take the Trust lead role regarding NHS Continuing Healthcare. 4.3 Discharge Steering Group To identify and develop the provision of assurance and evidence to comply with Department of Health policy and guidance and NHSLA standards regarding discharge from hospital by: Agreeing, promoting and implementing the good ideas within the NHS Achieving timely simple discharge from hospital toolkit and Ready to Go DH documents. Agreeing and monitoring an Action Plan. Streamlining discharge processes across the Trust, for both adult and children, to ensure in-patients are discharged appropriately, and in a safe and timely manner. To monitor systems and processes regarding discharge from hospital by producing a bi-annual report for the attention of the Quality Assurance Committee. To provide assurance and evidence to assist in meeting the core standard C6 and NHSLA Standards. 4.4 Care Co-ordinator A member of a nursing/midwifery team with delegated responsibility within the Trust for co-ordinating the discharge arrangements, including, liaison with PCT staff on the application of NHS Continuing Healthcare eligibility for individual patients. 4.5 Managers/ Matrons/Midwives, Ward Managers and Therapy Leads This group of staff are accountable and responsible for ensuring their own practice complies with the policy and for encouraging others to do so and for ensuring the policy is implemented and complied with, within their areas of responsibility; and for ensuring their staff are competent in following the policy. 4.6 Individual Employees Are responsible where indicated for ensuring :- Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page6

7 Due process is followed when patients are assessed and that account is taken of any carers needs by Considering whether carers are willing and able to continue in their caring role Carers are offered an assessment in their own right by alerting Social Care staff, where applicable, that carers may benefit from a carers assessment and/or carers have raised concerns about continuing their caring role. 4.7 Multidisciplinary/Multi-agency Team Health and social care staff who work together in planning discharge arrangements for patients with complex needs to ensure risks are minimised and patient outcomes are identified in a care plan. The team are also responsible for identifying any likely training needs of the carer(s). To consider and recommend patients eligibility for NHS Continuing Healthcare. 4.8 Consultant Medical staff and Other Designated Professionals To determine the patient s fitness for discharge once health interventions have been completed and/or determination that further intervention is not appropriate and, via their respective teams, informing general practitioners of the patient s stay, any follow up required and continuance of treatments including medication. Where care is not Consultant led designated staff must follow their approved protocols. E.g. Midwives complete a plan of care for transfer within Midwife Led Care, Nurses assessed as competent to ensure Nurse Led Discharges 4.9 Discharge Facilitators To provide specialist advice and guidance to clinical teams on all procedures relating to discharge from hospital, 4.10 Kite Team A dedicated team of specialist children s nurses who support families within the community who require help and advice where complex medical needs are identified. 5 Managing the Policy and Procedures for the Discharge of In-Patients 5.1 Principles of Discharge Applicable to All Patient Groups This policy takes cognisance of the need to give certain categories of patients particular attention when planning and delivering discharge care: Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page7

8 People who live alone, and/or who are frail and/or elderly, or who live with a carer who may have difficulty coping. Patients with a serious illness who may be returning to hospital at a later date for further treatment. Terminally ill patients. Babies and children, those with long term disabilities, and those whose parents seem unable or un-willing to care for them. Mothers whose new born babies have required special or intensive care. Patients with a continuing disability and those with sensory impairment. Patients with mental ill health/learning disabilities. Written discharge procedures, known as the Discharge Standard Operating Procedures will be agreed by the Discharge Steering Group and made available to relevant hospital and community based staff. The engagement of, and active participation of patients and their carer(s) as equal partners is central to the delivery of care and in the planning of a successful discharge or, in the case of mothers and babies, successful transfer to the community. Carers will be offered a carer s assessment where disclosures are made regarding their ability or willingness to continue caring or where staff suspect/observe difficulties in meeting the caring role. All staff should be aware that the process of discharge from hospital and the subsequent implications can be an anxious time for the patients/carers/families. Therefore, everyone involved in the planning process will be treated with respect and dignity. Where English is not the patient s first language, or where physical or sensory impairment or cognitive difficulties are evident, staff should request assistance from Patient Support Services or request an independent advocate, or make a referral to specialist staff e.g. Acute Liaison LD Nurse. Robust communications is a pre-requisite for well co-ordinated patient journeys from pre-admission through to patient discharge. It is essential therefore that there is communication at all levels within the system if there is to be effective partnership working between primary and secondary care and between staff and the patients and carers they are working with. Details of staff roles and responsibilities of those involved in the discharge planning process can be found in the Trusts Discharge Standard Operating Procedures Person centred multi-disciplinary assessment should be carried out at the earliest opportunity. The discharge planning process should begin at the point of hospital admission. However, admission may be avoided where timely assessments and interventions can be obtained in the community or within Assessment and Diagnostic areas and with assistance from the onsite Service Navigation Teams. Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page8

9 Specific responsibility is given to nurses/midwives as care co-ordinators, to effectively communicate with the patient/family/carers and to co-ordinate all arrangements for discharge planning, thus ensuring all relevant procedures are completed before the patient leaves. Nursing staff in adult services are responsible for ensuring the completion of the discharge plan. In Midwifery Services, the woman s hand held record and baby s child health record ( red book ) constitutes the discharge plan. All inpatients will have an identified planned discharge date, which should be regularly reviewed. If patients are transferred or outlied to other wards during their inpatient stay, this date should be communicated to the receiving ward and reviewed. All relevant information must be recorded on the Patient Transfer Form. All staff should work within a framework of integrated multidisciplinary and multi-agency team working in order that all aspects of discharge are managed effectively. Thus ensuring that where there are patients with complex needs, a multidisciplinary approach to discharge planning occurs and an appropriate plan for discharge is developed. The plan will be subject to review in light of changing circumstances. Where suspicions or disclosures are made concerning any vulnerable patients, prompt adherence to existing safeguarding procedures should be made. Arrangements will be made to provide patients with any necessary equipment/aids to daily living prior to discharge. This will include, where applicable, identifying where Telecare can assist promoting independence and choice and a means of risk management for patients and carers. Where appropriate, patients/carers will receive instruction on the use of aids and equipment prior to discharge as a means of encouraging self management. Where patients are identified as needing to return to hospital at a later date, staff should check and confirm that the patient/parents/person with parental responsibility understands why and, every effort will be made to provide details at the point of discharge. Adults, including older people, who do not require community support can be discharged without the need of referring to social services but may be given a contact number for the relevant Social Services Department should they require help in the future. On the day of discharge an E Discharge Letter will be sent to the patient s GP and the patient provided with a copy Advice from the Infection Control team is available to support the discharge of patients with known transmissible illness. Further detail is contained within the Trusts Infection Control Manual. Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page9

10 5.2 Principles Applicable to Children and Young People The goal of discharge planning for this group of patients is to facilitate a smooth transition back into the community as quickly and safely as possible. The discharge planning process will be based on multi-disciplinary team working with input from a core team of physician, social worker, health visitor and relevant specialist hospital staff. Assessments of discharge needs will address the question of the person s safety post discharge, any possible needs to return for further treatment and any anxieties mothers/person with parental responsibility may have where babies/children have required intensive care. When children and young people are leaving hospital particular emphasis will be made towards meeting the principles of family centred care and the Trust s philosophy for the care of children and young people. Older children must be involved in any discharge planning. A Discharge Plan must be completed for all children. Where children and/or young people require funding for complex needs and/or out of area placements, the care co-ordinator will liaise with the relevant PCT lead for Children s Services. Where children and young people have complex needs, including terminal care needs, the care co-ordinator will liaise with a member of the Kite Team who will ensure a multi-agency plan is completed following application of Continuing Healthcare criteria prior to discharge. A discharge summary will be provided which identifies the care they have received, their follow up management and planned medication etc. 5.3 Principles Applicable to Adult Patients Where adult patients are assessed as lacking mental capacity to make decisions regarding future care arrangements and have no one to act on their behalf, a referral for an Independent Mental Capacity Advocate should be made - see Trust Policy and Staff Guidance regarding Mental Capacity Act. Nursing staff must identify those individuals who may require health and/or social care support (including housing support) post discharge with health staff undertaking their statutory duties as described in the National Policy Framework for NHS Continuing Healthcare and NHS funded Nursing Care, Community Care Delayed Discharges Act and Mental Capacity Act. Staff should follow any agreed care pathways and jointly agreed processes. An acronym ASSURE has been developed by the Trust to reflect the interface of the Community Care Delayed Discharges Act and the National Policy Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Adults with complex and or long term conditions will be offered integrated assessment and planning of their health and social care needs. They will be Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page10

11 given the information they need to make informed decisions about their care and treatment and where appropriate, to support them to manage their own condition. Communications with these patients should clearly identify whether or not re-admission is a likely consequence of their progressing illness. Where applicable, liaison and involvement of community matrons in the discharge planning process will occur for patients with long term conditions to ensure that Right Care plans are in place. The discharge of older people or frail older people with high levels of dependency and complex health and social care needs requires careful planning, should be timely and be to an appropriate location. Some older people will require significant stays in hospital in order to achieve optimal health status and reach their potential. Person centred multi-disciplinary assessment should be commenced at the earliest opportunity, with the care co-ordinator facilitating timely referrals to other members of the multidisciplinary team. A multi-disciplinary approach to assessment of older people/frail older people is recommended to enable careful screening of the patient to determine whether the patient s needs are simple or more complex. Thus indicating who will require a fuller, more detailed assessment. The subsequent development of a care plan should include promotion of independence, with opportunities explored for rehabilitation whether this be in the person s own home with enhanced community support e.g. Enablement or, within a residential environment e.g. Community Hospitals. Care planning should also explore opportunities for people to receive Direct Payments to increase control and choice over their ongoing care. Patients will receive a review of their medications prior to discharge and where appropriate referral onto a Community Pharmacist will be arranged where there are concerns regarding medication compliance. Patients requiring medication calls only must be referred to Community Nursing Services as this element of care is no longer routinely undertaken by Social Care staff. Patients identified as nearing end of life should have their preferred place of death determined and efforts made to fast track their discharge. Further details of fast tracking patients for discharge is contained in the National Policy Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. A care pathway approach, for the management of patients last days of life e.g. Liverpool Care Pathway, will be commenced and carried through into primary care where applicable. Where patients do not have a suitable address to return to, prompt adherence to the jointly agreed Housing Protocol should be initiated and the Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page11

12 Trusts Discharge Facilitators advised of any potential delays in securing accommodation. Effective use will be made of transitional and intermediate care services, so that existing acute hospital capacity is used appropriately. Patients should therefore be assessed for a period of rehabilitation/enablement before any permanent decision on future care arrangements is made. A prompt sheet to help determine rehabilitation potential is available on the Trust Intranet. The assessment for, and delivery of NHS Continuing Healthcare will be organised so that patients and or their relatives/carers understand the continuum of care, their rights, and receive advice and information to enable them to make informed choices about their future care. Decisions regarding funding arrangements, for the ongoing care a patient requires following their acute episode of care, can be negotiated outside of the funding panels. Wherever possible, patients with complex needs requiring support from social care agencies and or community nursing services should be discharged no later than 5pm Monday to Friday unless by prior agreement with the providers of the service(s). Patients who refuse to be discharged should be dealt with promptly and sensitively. In essence this means good communication to elicit why the patient is refusing to be discharged and taking appropriate action to make the discharge happen. Where local resolution fails, ward staff should escalate the situation to their line manage and inform medical staff immediately as no one has the right to occupy a hospital bed un-necessarily. Staff will, where applicable, implement the Home of Choice protocol where ongoing care needs are commensurate with a care home placement. Where an in-patient s usual address is beyond Derby/Derbyshire or where in-patients are being discharged to relatives who live outside this catchment area, the host local authority social services department will be communicated with and a decision made as to who has responsibility for any required social care assessment and/or provision of services in order to ensure a safe discharge. Advice on discharge from hospital arrangements/planning for discharge from hospital can be obtained from the Discharge Facilitators or the Community Care Co-ordinator. Details of the systems and procedures involved in planning for patients discharge from hospital are contained on the Trust Intranet 5.4 Discharge of Adult Patients with Mental Health/Learning Disability Needs The after care needs of patients in the this client group must be assessed by health and social services before the patient is discharged. Such assessments will take account of the patient s own wishes and choices. Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page12

13 A care plan will be developed by the multi-disciplinary team and a copy of the plan given to the patient. Particular attention will be given to the patient s prescription and administration of medications, activities of daily living, questions of residence, the delivery of follow-up health care and the addressing of financial needs. Caring for people at home with mental health and or learning disabilities can pose significant pressures for carers. Carers will therefore be offered a carer s assessment and, where the local authority Fair Access to Care Services (FACs) is met a service will be identified and a carer s support plan developed. People with complex mental health needs, irrespective of whether they will be self funding or not, will be referred to Mental Health Services for expert advice regarding future management. In Maternity Services, this will be a direct referral to the Beeches Mother and Baby Unit. People with complex health needs known to Mental Health Services will require that Care Programme Approach (CPA) documentation is organised or reviewed for point of discharge. Patients without capacity and who are un-befriended will be referred to an Independent Mental Capacity Advocate. Where care home placements are being considered referral for an EMI Nurse Assessment will be made. Due consideration will be given to application of eligibility criteria for fully funded care. 5.5 Carers Research strongly suggests that that a number of us (one in ten) is likely to find ourselves providing care and support for a family member of friend at some point in our lives. The Trust is committed to working with the local wider health and social care community to translate commitment into practical action in order that carers have the opportunity to a life of their own alongside their caring role. Many carers express a number of difficulties including:- Coping with stress Getting a break from caring A lack of support from statutory agencies Worries about their own health Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page13

14 Concerns about money/financial issues Dealing with emergencies Combining work with caring Finding time for leisure activities Housing and Education It is imperative that staff be alert to the fact that some patients admitted are indeed carers and that a cared for person is vulnerable unless agencies are notified of the patient s admission in order that an emergency carer s plan be implemented. This will ensure that both the carer and the cared for person s needs are addressed in a timely manner. Staff must work with the carer to identify ways of meeting their needs and the needs of the cared for person prior to discharge. This may require offering advocacy services. Health staff will identify as part of their holistic assessment, those carers who provide substantial care to a cared for person, advice them of their right to a carers assessment and signpost them to where help and assistance can be obtained and/or, with consent, make contact with the relevant social care agency. Where appropriate, Social Care agencies will liaise with Housing and or Education Departments. Any concerns raised by a patient who is a carer, must be responded to swiftly and in a sensitive manner. Staff must invoke Safeguarding procedures where a disclosure indicates the safety and well being of the carer or the cared for person. 5.6 Documentation to Accompany the Patient Written information about lifestyle, diet, medication and where to obtain help and support should be identified on the Discharge Plan/Checklist/Hand Held Record and made available, where appropriate, prior to discharge. Arrangements for follow-up care will be made prior to patients/carers leaving hospital and they will be provided with such details and where appropriate, copies of salient information e.g. District Nurse Referral Form, detailing current and ongoing care requirements and a copy of Treatments to Take Out (TTO Form) which details whether medications need to cease on completion of the course or whether further supplies need to be obtained from the patients General Practitioner. Written information for example, Leaving Hospital - Patient/Relative/Carer information on discharge from hospital and Leaving Hospital A Guide for Older People and Carers, will be available, for patients/carers/relatives throughout the Trust. Other patient condition specific information made available to patients/carers will be detailed on the Discharge Plan. Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page14

15 In Midwifery Services the hand held record will be held by the mother/responsible guardian. New mothers will be provided with current public health guidance relating to keeping their baby safe. For example Back to Sleep. In Children s Services, a Discharge Summary will be provided to the parents/person with parental responsibility 5.7 Discharge Out of Hours The discharge time for patients who do not have complex needs will be agreed between the patient/relative/carers and the care co-ordinator. In all instances staff should be promoting am discharges Consideration will need to be given to the method of transport to be used. In all instances patients own transport should be considered. No discharges via ambulance transport will routinely occur on Sundays or public holidays. 6 Monitoring Compliance and Effectiveness Monitoring Requirement: To monitor the degree of compliance with the minimum requirements contained within the policy and procedures by: Discharge requirements which are specific to each patient group Documentation to accompany the patient upon discharge Patients/carers have access to up to date information on discharge from hospital e.g. leaflets/booklets Key Discharge Performance Indicators (KPI s) identified by Commissioners Trends relating to discharge complaints/incidents raised by staff and reported via Datix Monitoring Method: Social Care Service Managers will inform the Trust on a quarterly basis of carer needs assessments undertaken by its staff or representatives of the social care organisations Review of delayed discharges reported via the agreed Sitrep mechanism Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page15

16 Weekly monitoring of all am discharges Review of Health Records and ward assurance audit data relating to discharge documentation Review of Datix incident and complaint data relating to discharge Reports received on the efficient use of hospital transport on discharge, discharge medication issues, the ordering from Integrated Community Equipment Services. Report Prepared by: Monitoring Report presented to: Community Care Co-ordinator Discharge Steering Group Frequency of Report: Six Monthly 7 References NHS and Community Care Act 1990 Community Care Delayed Discharges Act (2003) Children Act (1989) Welfare of Children and Young People in Hospital (1991) Safeguarding Children Procedures (2007) Safeguarding Adults Procedures (revised) (2008) Discharge from Hospital: Pathway, Process and Practice (2003) Mental Capacity Act (2005) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2007) amended 2009 Housing Protocol (2008) National Strategy for Carers 1999 Carers (Equal Opportunities) Act 2004 Carers at the heart of the 21 st century, families and communities 2008 Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page16

17 National Service Framework for Older People 2001 National Service Framework for Long Term Conditions 2005 Care Quality Commission Outcomes 2009 Service Standards for Discharge Care (1996) NHSLA April 2008 Risk Management Standards for Acute Trusts Ready to Go? DH 2 Policy and Procedures for the Discharge of In-Patients V4.1 March 2011 Page17

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