Main navigation

Implementing the Discharge to Assess model during the COVID-19 pandemic

Supporting the system in freeing up hospital beds and helping patients on the road to recovery

The challenge

As the COVID-19 pandemic began to ramp up in the UK, Government set out a mandate for how health and care systems and providers should change their hospital discharge and community support arrangements in order to be able to manage the predicted increase in patients needing acute hospital beds.

Strict timescales were given for patients to access one of the following pathways:

  • Those well enough to go straight home with no further treatment
  • Those who could recover at home with some further assistance (for example from district nursing or through assistive technology)
  • Those who would need to go in to an intermediate care setting for rehabilitation
  • Those who would need to be placed in a care home following a life-changing event (for example a stroke)

There would, of course, also continue to be the provision of end of life care.

We had to implement a robust solution, in partnership with the wider system, which would quickly and safely determine which pathway patients required and swiftly enable them to access the pathway.  We had to make sure that patients were getting the right care under extremely pressured circumstances.

Virgin Care
Virgin Care

The solution

Virgin Care already had an effective Discharge to Assess (D2A) model but during the pandemic we have been able to strengthen this with the support of the wider health systems we work in across the country.

We have worked closely with partners including acute hospital trusts, social care, primary care, mental health, local authorities, CCGs and third sector organisations to refine local Standard Operating Procedures, map the D2A pathways and transform services in the community to support the safe and timely discharge of patients.

Patients are screened in the hospital settings by multi-disciplinary discharge teams. A discharge co-ordinator leads on this work to ensure that the patient is on the correct pathway and makes sure that the right health professional follows the patient out of hospital.

We implemented this in many areas of the country including West Lancashire, Kent and Bath & North East Somerset.

In West Lancashire, the existing discharge planning service that we had in place was extended to prepare for and during the first COVID-19 peak to offer an 8am-8pm service, seven days a week. We lead the service in partnership with Sefton Council social services team and Lancashire Care Foundation Trust.

The service is easy to reach through a single point of access. Coordinators are trained to deal with any queries, with assistance from clinicians and pathways to third sector support. Supporting the smooth running of these pathways can create capacity within the acute sector to deal future COVID-19 peaks and on-going sustainability.

D2A managers ensure that the teams have access to daily huddles and a management decision hotline, and carry out daily assessments on any COVID-19 risks as they emerged. Managers have daily ‘end of day’ huddles to review the wider impacts of any resource changes and emergency guidance that emerges.

Community services teams across Virgin Care continue to support patients after they have left hospital and, whilst there are still face-to-face appointments where necessary, there are also a variety of digital solutions available. We have introduced virtual consultations, e-clinics, tele-monitoring and telecare.

In West Lancashire, we also procured and implemented an assistive technology service, offering free monitoring devices and an assisted lifting service to patients, on behalf of NHS West Lancashire Clinical Commissioning Group,
As well as supporting those leaving hospital, we have also worked as part of the wider system to help avoid further admissions.

In West Lancashire, a risk stratification approach is applied to support the shielded group and people known on our community caseloads, and we have used this, working closely with the local authority, to identify people who may be on the cusp of going in to hospital.

The system can then ensure that those people receive the support they need to help avoid a hospital admission, through our own adult community services or by providing day-to-day support through the West Lancs Together volunteers, whose activities include collecting prescriptions and delivering food to vulnerable residents.

The outcomes

Working so closely with our acute trusts and other partner organisations to provide effective hospital discharge and community support services during the pandemic has strengthened our pathways and the way we work together as part of a wider health system.

Not only have we been able to support patients in leaving hospital and returning home safely and in a timely manner, we have also helped to keep hospital beds free for those who need it most by providing the right kind of care for people in the community.

As an example, over a four month period our community services team in West Lancashire saw 173 people in the community who would have otherwise automatically gone in to hospital. Only 15 of those 173 did end up needing to be admitted to hospital for further treatment.


Virgin Care
Virgin Care

How we worked with four local authorities, two Clinical Commissioning Groups (CCGs) and NHS England to deliver sexual health services and make a difference in the Teesside community.

Virgin Care
Virgin Care

Clinicians at our Cheshire West and Chester Integrated Sexual Health Service were given a Feel the Difference Grant to pilot a new way of supporting HIV and sexual health patients.

Virgin Care
Virgin Care

Breastfeeding rates in Wiltshire are above the national average, but our commissioned service is keen to ensure that more women are able to breastfeed and for as long as they want to.

Virgin Care
Virgin Care

Find out how we halved the number of people being prescribed Pregabalin in HMP Norwich to improve patient health outcomes.