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Oxford University Hospitals NHS Foundation Trust

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Leaving hospital

We hope we have made your stay as comfortable as possible. Our aim is to get you home as soon as you are well enough. If you need further treatment this can be done in the comfort of your own home or a community hospital; this then helps us to free up beds for the most seriously ill patients.

What we will do

  • Planning for your discharge will start on or before admission where possible. We will discuss your estimated date of discharge, your needs, and together agree a plan.
  • Most patients go back home when they leave hospital; if you need community support services these can be arranged.
  • If your care needs can best be met in a community hospital, we will find and transfer you to the first available bed.
  • There are nine community hospitals in Oxfordshire, so the first available bed may not be the one closest to where you live.
  • Our aim is to get you well as soon as possible.

Community hospitals

Community hospitals often act as a bridge between hospital and home, particularly for elderly patients who may need rehabilitation to help them regain their independence as they recover from an illness.

The number of inpatient beds each community hospital provides varies, as does the range of services they offer.

Many community hospitals also provide day services, outpatient clinics, and therapy services. Some also provide Minor Injury Units.

There are a number of community hospitals in Oxfordshire :

Community hospitals - Oxford Health NHS Foundation Trust

Help after you get home

Home Assessment Reablement Team (HART)

The Home Assessment Reablement Team (HART) provides a short period of care and support to patients as they regain their independence.

Home Assessment Reablement Team (HART)

Care packages

If you had a care package paid for by your local council before coming into hospital, please bring all carer or care package details, including contact name and number.

If you require support from social services, who pays for it?

If you need further care once you leave hospital, a social worker will determine how much help you will receive to pay for your personal care.

Depending on your financial situation, you may have to contribute to the cost of your care. Your social worker will ask you to complete a financial assessment form. You have seven working days to do this – ask your social worker if you need help to fill it in.

Sometimes living at home is no longer a practical option. We will work with you to decide the best course of action and transfer you to a community hospital bed so that you are able to reach your full potential. From there a team of nurses, social workers and therapists will discuss your future needs.

Self Directed Support

Self Directed Support (SDS) is the process by which a person has choice and control over the support that they need in order to go about their daily lives. It is about arranging care to suit a person's individual preferences, such as staying in their own home. It allows greater flexibility and creativity to meet individual needs.

If you have Self Directed Support in place, you are responsible for re-starting the care, and a referral to social services is not required. If an increase is required it may be that there is enough in your budget to arrange extra support for a short period. If this is the case, you and the ward staff will discuss options for your care with the hospital social work team.

Continuing Healthcare

Continuing Healthcare is a scheme which provides NHS-funded care, for people with complex and unpredictable needs. Depending on your situation and the level of care required, this can be provided at home, in a nursing home or in a NHS-funded bed.

There is specific national guidance on who qualifies for Continuing Healthcare. The ward team caring for you will complete an assessment if they think you might qualify. For more information about Continuing Healthcare, please ask for the information leaflet 'NHS continuing healthcare and NHS-funded nursing care' or download it from the Department of Health website.

What we expect from you

We will expect you to be fully involved in planning your own discharge, together with a relative, carer or friend as appropriate.

  • Make sure you have all your belongings, including any valuables from the hospital safe.
  • Make sure you have outdoor clothing and your house keys.
  • Make sure you have food and drink available at home, and if necessary ask someone to turn on your heating.
  • Make arrangements for adults or children you normally care for.
  • Please let us know the day before discharge if you require a medical (sick) certificate.

Transport

We expect you to arrange your own transport home. However, make sure you speak to ward staff about when your relative and/or carer should arrive, as often the hospital will need to organise medication and appointments etc.

Hospital transport is for people with a medical need only.

Medication

Medication which you brought into hospital, and still need, will be returned to you. If you have started new medication, you will be given a supply to take home. Your GP will then prescribe more if required.

We will explain your medication before discharge. There are also written instructions on the packaging and an information sheet will be provided.

For further information about your medication please call:

Patient Medications Helpline: 01865 228906
Monday to Friday 9.00am - 1.00pm

Day of discharge

We will aim to get you 'Home for Lunch' on your day of discharge wherever possible. We will ask you to move from your bed space to the Transfer Lounge or day room early in the day. This way we will be able to admit another patient and begin their treatment. The Transfer Lounge is staffed by qualified nurses and will provide drinks and meals; here you can wait in comfort for your medication and your transport home.
We will give you:

  • a discharge letter detailing your hospital stay and further treatment
  • medication or equipment as required.

We will send a discharge letter to your GP explaining the reason for your hospital stay and giving details of your medication.

Follow-up appointment

If you need a follow-up appointment or further investigations, we will arrange this before you leave, or you will receive a letter after discharge from hospital.

Help at home and equipment

If you and your team agree you need help at home, a discharge letter detailing support services will be sent to your GP. The support services will be arranged before your discharge. If you require equipment at home, arrangements will be agreed with you.

If you have any concerns once you are at home, please either contact your GP, or the Social and Health Care Team.

Social and Health Care Team: 0845 050 7666

Leaflet

Leaflet: 'Planning your discharge - making preparations for your return home (pdf, 200 KB)

Support for carers

Do you look after someone? Carers Oxfordshire listens to carers and provides information and advice. It also aims to help carers get the support they may need.

Let us know your views

We welcome your views on the care you have received in our hospital. Please ask your nurse for a patient feedback form or email us.

Email: feedback@ouh.nhs.uk

DEPARTMENTS AND SERVICES