Entering and leaving hospital

Many people do not need support from Adult Social Care following a hospital admission. However, if you are in an NHS hospital and will need care and support after you leave, the hospital will be able to make a referral to our Social Care Teams. We have Social Workers who are based at Darlington Memorial Hospital and we work in partnership with hospital staff and community health providers.

Emergency Admissions

If you, or your carer, are admitted to hospital in an emergency we have a responsibility to consider if we need to make arrangements on your behalf to:

make sure your property is secure and/or
make sure any pets are looked after. Ideally arrangements will be made with a family member, friend or neighbour.
where this is not possible we will arrange a cattery, kennel or similar.
you may be expected to pay any reasonable costs for us to make these arrangements.

When you arrive at the hospital, you should be given information about the process when leaving hospital.

Whilst you are in hospital staff should discuss with you what kind of care and support you are likely to need after your discharge. If you are likely to be supported by family or carers they should be involved in these conversations.

You will be treated in hospital until you are well enough to leave. Your care and assessment may continue outside of hospital. The hospital will work with you to plan your discharge.

Discharge from Hospital

When you are ready for discharge the hospital may facilitate your discharge without any contact with Adult Social Care in the following circumstances;

no new or additional health and/or social care and support.
self-management with signposting to services in the community
voluntary sector support.
re-start of pre-existing home care package at the same level that remained active and on pause during the person’s hospital stay.
returning to original care home placement with care at the same level as prior to the person’s hospital stay.

The hospital will communicate this with you and your family to facilitate discharge.

If it is felt you are going to need support on discharge from Adult Social Care, the hospital will make contact to Responsive Integrated Assessment and Care Team (RIACT) Team on 01325 342111.

You may be discharged home and assessed by our Reablement Coordinators or if you need an assessment prior to discharge the Social Workers and Community Assessment Officers within the team will work with you, your family and the hospital and coordinate your discharge. The following options will be considered, however will be determined following an assessment;

home-based intermediate care on a time-limited, short-term basis for rehabilitation, reablement and recovery at home
re-start of home care package at the same level as a pre-existing package that lapsed.
returning to original care home placement with time-limited, short-term intermediate care
long-term care and support at home following a period of intermediate care in the community.
care home placement for assessment of long-term or ongoing needs and facilitation of patient choice in relation to the permanent placement.
long-term care and support in a care home following a period of intermediate care in the community.

Hospital Transport Services

If you or a family member need to attend hospital appointments, you may be eligible for patient transport.

For other transport options for hospital visits please see

If you require support in relation to transport, please see NHS Patient transport service[external link]

Equipment and adaptations to your home

Mobility equipment such as wheelchairs and walking aids or adaptations to your home may be required to overcome some of the difficulties you may have living at home. If needed a therapist will undertake a functional assessment with the view to recommending the equipment or adaptations.

Funding your Care

You may be assessed as being eligible for intermediate care, which would be free for up to 6 weeks. Intermediate Care could include a package of are within your own home provided by the Reablement Service or a period in and Intermediate Care bed within a 24 hour care setting.

If your needs are predominantly health you may qualify for Continuing Healthcare which is a fully-funded package of care that some people are entitled to receive as a result of disability, accident or illness. It covers the full cost of the person's care and residential accommodation.

If your Social Worker completes a Care Act assessment and you are eligible for care, but don’t meet the criteria for Intermediate Care or Continuing Health Care, you may be required to financially contribute towards your care. Your Social Worker will support you in arranging a financial assessment[external link]

If you require support from Adult Social Care, prior, during or following your hospital admission, you can contact the Adult Contact Team on 01325 406111 who will be able to support and/signpost as necessary

Section 117 aftercare

Some people who have been detained in hospital under the Mental Health Act they may be able to get free help and support when they leave. This is called Section 117 aftercare.

‘Aftercare’ means the help you get when you leave hospital.

You will not be required to pay a contribution towards your assessed Section 117 aftercare needs.

A joint decision is needed between Health and the Local Authority to end Section 117 aftercare.

For further information visit www.mind.org.uk