Supporting Service Users on Discharge from Hospital
We piloted this service alongside other agencies in 2024/25 to support people on discharge from hospital who have been assessed as having no needs in discharge.
Our Settling In Service is designed to support people who have recently been discharged from hospital and have been assessed as having no immediate support needs.
We understand that the transition from hospital back to home can still feel overwhelming, even when no ongoing care needs have been identified at discharge. That’s why we offer a short period of follow-up support to help ensure you remain safe, well, and confident at home.
How the service works
We will contact you shortly after your discharge to check in and see how you are getting on. During this call, we will:
- Ask how you are managing at home
- Check whether your needs have changed since discharge
- Offer advice or reassurance if required
We will then make up to two further contacts over a two-week period. These follow-up contacts allow us to continue monitoring your wellbeing and provide additional support if needed.
If your needs change
If at any point we identify that you may need additional support, we will work with you to ensure the right help is in place. This may include referrals to:
- Our Adult Services or Carer Support Services
- Other appropriate partner agencies and community services
Our aim is to make sure you have the right support to remain independent and well in your own home.
Our commitment
The Settling In Service provides reassurance during the early days after discharge, helping to bridge the gap between hospital and home life. We are here to check in, listen, and ensure you are supported if your situation changes.