Market Engagement for Discharge to Assess

To provide timely discharge for adults from hospital as part of the discharge to assess model. This discharge route is for adults who are likely to need a further period of assessment for a short period of time with a focus on therapeutic and reablement input to optimise functional ability and reduce reliance on care or early readmittance to hospital. This will move life changing care decisions outside of the acute hospital environment, allowing time for adults and their families to make informed decisions and reach long term plans where a further assessment cannot be completed in the adult's home. Providers would be expected to work with people using an asset-based approach, building on their strengths, and agreeing goals for each adult that lead to greater levels of independence and self-care.The Services shall be provided in accordance with the standards of care and other regulatory obligations such as CQC and as detailed in the ADASS Contract.The aim of this service is to: • Support the discharge flow from the Acute Hospital in line with the Discharge to Assess model outlined in the National Hospital Discharge Service Policy.• Support adults that require step up provision from the community to avoid hospital admission• Provide an assessment/reablement approach 24/7 supported by statutory community services, which maximises every opportunity to keep adults as independent as is possible. • Provide necessary care in a safe and timely manner to adults who are deemed medically optimised but require interventions that cannot be provided in their own home. • Support adults to achieve agreed objectives aimed at optimising health, wellbeing, and independence.• Minimise the need for adults to be re-admitted to acute hospitals including working closely with the Early Intervention Team to manage urgent care needs and facilitate timely transfer from acute hospital care, releasing capacity within the acute services at West Suffolk Hospital, to enable acute services to focus on caring for the most vulnerable service users. • Support adults who have more complex care and support needs.• Support and engage with the use of digital technology as part of any assessment process, this may include virtual wards.• Respond to referrals in a timely manner and accept admissions 365 days a year (including bank holidays and weekends). The objective of the service is to: • To be part of the multi-disciplinary team providing 24/7 therapeutic support, reablement and care as appropriate.• Involve the adult at all stages of their care planning, so they remain in control of their own lifestyle.• Help reduce possible dependence on carers / family or care packages.• Promote independence and improve outcomes for adults recovering from illness, injury, or trauma by providing individualised support to enable them re-gain sufficient physical functioning and confidence.