Adults with Incapacity - delayed discharge: good practice guidance September 2023

6. Recommendations:

Through our discussion we have heard of lots of positive practice implemented to reduce pressures on delayed discharges where AWI was an underpinning factor. During the meetings we were able to share some of these good practice examples and encourage areas that were still facing pressures to implement some of the changes as advised. We were also able to engage directly with an area that was performing strongly to gain some inter HSCP support.

In light of winter pressures and planning we would encourage areas to review their delays where AWI is an issue and consider implementing the following actions:

1. Consideration should be given to sessional MHO recruitment to support the wider MHO workforce, and to potentially use these staff to focus specifically on delays where AWI is an issue.

2. Training – HSCPs should ensure their workforce is fully aware of AWI legislation and practice. The Scottish Government is funding NHS Education for Scotland and the Mental Welfare Commission to deliver AWI training to the health and social care workforce. This is ongoing and resources will continue to be added to the Turas page for AWI for the duration of the project, due to complete in February 2024. The page is accessible to anyone who is registered for a Turas account.

3. HSCPs should consider integrating social workers and at least one MHO to their Hospital Discharge teams. Those partnerships that have done this report reduced delayed discharges due to more robust discharge planning and an effective communication process across the wider multi-disciplinary team involved in care planning and support. This was highlighted as being particularly effective around engaging with medical staff regarding the need for their reports.

4. HSCPs should prioritise recording systems or AWI tracker processes to show the stage of the delay and highlight any emerging issues. Where possible we would encourage this information to be reviewed daily by senior management to ensure that the patient is progressing to discharge without delay. This recommendation again supports good practice and the evidence from HSCPs who robustly manage their delays daily is that delays are reduced as a result.

5. HSCPs should have daily contact with support providers to be sure they have an accurate picture of social care staffing support and available support hours. Where this worked really well it was reducing delays to the point where admissions were prevented.

6. Section 13ZA remains a helpful tool. If an individual is being considered for support via section 13ZA, supported decision making practice should be used, and independent advocacy for the individual should be considered. Anyone subject to section 13ZA should have a review of their care management.

However, HSCPs should be aware that section 13ZA cannot be used as an authority for implementing a care plan where the adult does not agree with the proposed action or where it is thought that the individual is unlikely to remain in or agree to the care arrangements. It should also not be used where any other care parties involved voice an objection.

7. Key team members in HSCPs should develop working relationships with the local Sheriff court staff, so there can be easy communication about court delays. HSCP areas can also contact the Scottish Government for further guidance if local avenues have been exhausted.

8. HSCPs should set timescales for intervening to check that families are engaged in the private guardianship process. This should also include checking on the progress of the family with engagement of a solicitor and any legal aid applications. Monitoring the process in this way means if the private application is not progressing timeously remedial steps can be taken.

9. Wherever possible HSCPs should consider the application for an interim guardianship order where a placement is identified. An interim guardianship can be granted without a hearing, and this can save a few weeks in the process.

10. HSCPs should ensure the promotion of powers of attorney at appropriate stages in working with adults in health and social care.