Being discharged from hospital...

[Pyracant]

My dad (87) lives in England and I live in Wales. If my dad can't be discharged safely to his home, how can I make arrangements to have him safely discharged to my home in Wales if a care package is needed. Is Discharge to Assess relevant?

Thank

[MichaelJH Heart Star]

I am currently in a DTA bed. In my opinion they can be helpful as long as all agencies progress things which unfortunately is not always happening (and not just in my case). The best starting point is probably to speak with the hospital social worker. OT and other assessments may be necessary.

Have you thought about things longer term. For instance would it be appropriate for your mum and dad to move into ovet-60s accommodation near you? Please feel free to PM if you wish.

[Pyracant in reply to MichaelJH]

Thanks Michael...Ive been on the phone for a lot of the day trying to find the best way through a system that is a bit like a maze...I think that it's going to take a while to resolve, but I greatly appreciate your advice.

[Hidden]

I would suggest you take some specialist advice on this, with the first port of call probably being citizens advice to begin with - it’s been a while since I’ve had to access advice specific to Wales, and most of what I did need to access was child-centred, so not relevant to your situation. Age Cymru might also be a good avenue for advice and further signposting, and in actual fact I might advise you try them first. The issue I suspect you’re going to find potentially problematic is that even if DTA is appropriate, it functions within NHS England, with no current universal equivalent available in Wales, and cross border arrangements between England and Wales are almost entirely financially driven: under NHS England rules, the originating CCG is responsible for the cost of care unless the patient permanently moves, meaning cross border placements or care provision are rarely considered appropriate unless it’s literally the only placement available. Equally, NHS Wales will not be willing to foot the bill for a patient that is still technically an English patient, permanently resident in England and registered with English services. The ‘easiest’ answer is to register your dad as a permanent resident at your local GP, but only in so far as it resolves the likelihood of funding disputes: any official move between the two countries i.e. registering your dad as permanently resident at your address, will obviously result in needing to be re-referred in to all services and specialities, which in my own experience can take a very long time to sort out even with direct referrals for care between specialist units. I’ve done it in both directions, and the transfer of essential records alone can take 6 to 12 weeks, and coming back from Wales to England 2 years ago, were incompatible with NHS England’s systems: a lot of my daughter’s data, including all her vaccination records etc., couldn’t be ported over between the two systems, so the English services have no records for many things they should do. My data is also incomplete, and I’m given to believe the same is currently true going from England to Wales due the variation in IT systems.

The other issue to bear in mind is that the above also applies to any social care input provided by the LA in agreement with the local CCG e.g. provision of domicillary care where assessed as required as part of a care package.

I’m really hoping I’m being overly pessimistic and that you find it’s actually really straight forward, but it’s the nature of the move (essentially ‘mid care’) and resultant financial implications for the respective NHSs that makes me suspect one or both sides may try and kick up a fuss. I’d be really keen to know how you get on, though.

[Pyracant in reply to Hidden]

Thanks Charlie, I greatly appreciate the time you have taken to write your email with your experiences. I've been on to the various bodies today and it does seem like it is going to be a bit of a challenge, but ar least I've made a start!

[Hidden in reply to Pyracant]

The cross border medical situation between England and Wales really is a bit of a farce, particularly when money is the primary consideration, rather than patient care, and there are a significant number of services/procedures not available in Wales, so Welsh patients frequently have no choice but to travel over the border 🙄 As you say, at least you’ve made a start, and I’ve found knowing something might not be straightforward is always preferable to thinking it will be only to suddenly find it’s not partway through. I hope you do get it sorted quickly for the sake of you and your dad, though, and wish you all the very best with it.