Post No4….Hospital Discharging on the D2A Pathway – What is it?

Introduction:

In this post I will be explaining the purpose of the D2A (Discharge 2 Assess) pathway and how it is funded. The D2A process is often something of an unknown to families, although they may have heard the term being used by the hospital discharge team at some stage.

I will be looking into what the D2A pathway is, why it is being used by hospitals, who pays for it, what happens afterwards and what choices families have in terms of a care home placement. And so…….

What is the D2A Pathway?

In essence the D2A pathway is a funding mechanism that enables hospitals to discharge patients from their care into the community, normally to a care home or a specific D2A facility run by the NHS.

This was used heavily during the early stages of the pandemic, when the government wanted patients out of hospitals as quickly as possible by empowering local authorities with the funding to do so. Today, the D2A pathway still presents a very useful way of assessing people in the community rather than in the hospital, and also acts as a step down pathway from hospital, to care home, to home.

Why is it being used by hospitals?

We all hear of the pressure the NHS is under, but seldom do we really realise just how much. Hospitals are now not only busy in the winter but also in summer months, with capacity levels stretched and beds in short supply. Having a method of discharging patients and preventing bed blocking is therefore a very useful tool that’s helps hospitals manage patient flow.

Who pays for it?

The D2A pathway is funded by the local authority via the government budget, it provides either full funding or an agreed funding level with the care provider and does not need to be repaid by the patient. Officially, the D2A pathway lasts for 4-6 weeks, although I have experienced a number of cases where the time frame is much longer. In such circumstances, the local authority continues to pay the care fees to the care provider and the fees still do not need to be repaid by the patient.

What happens after 6 weeks (or however long…)?

This is an important question, the process for coming off of the D2A pathway involves an assessment from a Social Worker, who is trying to establish who will fund the placement in the long term. The 3 possible outcomes are:

· The placement is funded in full via Continuing Health Care (CHC)

· The placement is self-funded

· The placement is funded by the local authority

It is really important to consider the longer term when discussing a D2A discharge with the hospital. Moving from hospital into a care home can be very challenging for the patient, and so moving again from one care home to another is not advised if it can be avoided. With this in mind, it is worth noting that the longer-term funding capabilities should be considered at the early stages of this process to prevent a second move.

Can I choose which care home I want to use?

This is the one big snag with the D2A pathway ☹ choice can be very limited. When a patient is discharged on the D2A pathway, the hospital discharge team will broker the discharge to all care homes on the list via email, which will be many. With cost being the main driver, the family may not necessarily get their chosen care home or may have to travel much further than they would prefer.

I have however experienced two ways where families have regained some control over this process:

1) If there is a shortage of available beds in the area for the required care type, and the chosen home has availability, or

2) There is an extremely strong reason why the chosen care home should be prioritised, but this is very rare.

Although families can by-pass the D2A pathway by self-funding in the chosen care home, it is not something to throw away lightly, as the D2A pathway represents a significant saving to the patient.

Conclusion:

The D2A pathway has both pro’s and con’s, on one hand it allows a significant saving to families but in the other it potentially strips them of control and choice. It is always worth talking to the hospital discharge team and understanding if they are considering discharge via the D2A pathway so you can make a plan, and to work with the hospital to ensure a safe and timely discharge wherever possible.

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