Quality statement 6: Discharge plan

Quality statement

People who are vulnerable to the health problems associated with a cold home who will be discharged to their own home from hospital, or a mental health or social care setting have a discharge plan that includes ensuring that their home is warm enough.

Rationale

If people who are vulnerable to the health problems associated with a cold home are discharged to a cold home it can lead to new illnesses or worsening of their existing condition and readmission. When a person is identified as being vulnerable to the health problems associated with a cold home, their needs can be addressed through a discharge plan (at any time of the year), which can be started at a pre‑operative planning appointment or as soon as possible after admission. This may involve support from a single‑point‑of‑contact health and housing referral service. Sometimes immediate steps can be taken to ensure the home is warm to return to, for example by asking a family member or neighbour to switch the heating on in advance.

Quality measures

Structure

Evidence of arrangements for people who are vulnerable to the health problems associated with a cold home who will be discharged to their own home from a care setting to have a discharge plan that includes actions to ensure their home is warm enough.

Data source: Local data collection.

Process

Proportion of people identified as being vulnerable to the health problems associated with a cold home being discharged to their own home from a care setting who have a discharge plan that includes actions to ensure their home is warm enough.

Numerator – the number in the denominator who have a discharge plan that includes actions to ensure their home is warm enough.

Denominator – the number of people identified as being vulnerable to the health problems associated with a cold home being discharged to their own home from a care setting.

Data source: Local data collection.

Outcome

a) People who are discharged from a care setting who feel able to manage their home heating needs.

Data source: Local data collection.

b) Delayed transfers of care.

Data source: Local data collection.

c) Readmission rates.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (such as hospitals, mental health inpatient settings and social care residential settings) ensure that discharge plans, at any time of year, include actions to ensure homes are warm enough for people who are vulnerable to the health problems of cold homes. The discharge plan may include referral to services that provide help to reduce any risks identified.

Health and social care practitioners (such as occupational therapists, nurses and residential care managers) ensure that discharge plans include actions to ensure homes are warm enough for people who are identified as being vulnerable to the health problems associated with a cold home. This discharge plan may include referral to ensure they have help to reduce any risks identified. Any immediate and practical needs, such as the heating being switched on before they arrive home, should also be arranged.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that the hospital, mental health inpatient and residential social care services they commission provide discharge plans at any time of year that include actions to ensure that homes are warm enough for people who are identified as being vulnerable to the health problems associated with a cold home. The discharge plan may include referral to services that provide help to reduce any risks identified.

What the quality statement means for patients, people using services and carers

People who are vulnerable to the health problems associated with living in a cold home who are going home after a stay in hospital or a mental health service or a social care service (for example a residential care home) have a 'discharge plan' that includes help to keep their home warm. This should be provided whatever the time of year. They are also given help before they go home, if they need it, for example arranging for someone to switch their heating on so that their home is warm when they arrive.

Source guidance

Definitions of terms used in this quality statement

People who are vulnerable to the health problems associated with a cold home

People living in cold homes who are vulnerable to the associated health problems include:

  • people with cardiovascular conditions

  • people with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)

  • people with mental health conditions

  • people with disabilities

  • older people (65 and older)

  • young children (under 5)

  • pregnant women

  • people on a low income

  • people who move in and out of homelessness

  • people with addictions

  • people who have attended hospital due to a fall

  • recent immigrants and asylum seekers.

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6) and expert opinion]

Discharge plan that includes ensuring that the home is warm enough

To ensure a person's home is warm enough, the discharge plan may include simple, immediate tasks, for example switching on the heating before the person arrives home so that it is not cold. They may also be more complex interventions, such as home improvements or assistance with heating tariffs, for which referral to the single‑point‑of‑contact service is needed. Some people will need both immediate help and referral to the single‑point‑of‑contact service.

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6) recommendation 7]

Health problems associated with a cold home

Cold homes and poor housing conditions have been linked with a range of health problems in children and young people, including respiratory health, growth and long‑term health. In older people, cold temperatures increase the risk of heart attack, stroke and circulatory problems, respiratory disease, flu and hospital admission. They also lower strength and dexterity, leading to an increase in the likelihood of falls and accidental injuries. Home temperatures also have implications for mental health because cold is linked with increased risk of depression and anxiety.

[Adapted from Local action on health inequalities evidence review 7: fuel poverty and cold home-related health problems (2014) Public Health England]

Equality and diversity considerations

Good communication between health and social care practitioners and people who may be vulnerable to the health problems associated with a cold home is essential. Those at risk are likely to include people with communication needs, people who are frail or confused, and people who have difficulty understanding when asked about their home heating needs.