Better Care Plan engagement report: an evaluation of Salisbury NHS Foundation Trust Early Supported Discharge Service for patients with fractured neck of femur

This report evaluates Salisbury NHS Foundation Trust’s Early Supported Discharge (ESD) service for patients recovering from a fractured neck of femur. The service was introduced in October 2016 to help patients leave hospital as soon as they are medically fit and continue their rehabilitation and reablement at home. Healthwatch Wiltshire was asked to independently gather feedback from patients and unpaid carers about their experiences of the service. 

Healthwatch Wiltshire collected evidence through focus groups, patient questionnaires, and Friends and Family Test surveys. Seven people attended the focus groups, while 25 completed questionnaires and 45 Friends and Family Test responses were analysed.

Overall, feedback about the service was overwhelmingly positive. Most patients said they wanted to return home as soon as possible, and they felt that the ESD team's support enabled them to leave hospital earlier than would otherwise have been possible. Patients consistently praised the professionalism, kindness, flexibility, and responsiveness of the team. 

Patients reported that discharge plans were generally well explained and that they felt confident about returning home. Many said that members of the ESD team visited them on the day of discharge, helped them settle in at home, checked that equipment was in place, and ensured they could move around safely. People valued having a contact number for the team and appreciated the prompt responses when concerns arose. 

The report found that support was tailored to individual needs. Patients felt they received enough rehabilitation support and encouragement, particularly with exercises and regaining mobility. Some participants believed that this support helped speed up their recovery. 

Although experiences were positive overall, some issues were identified. A small number of patients experienced problems with discharge arrangements, including delays obtaining medication, unclear discharge instructions, confusion about suture removal, and limited notice of discharge dates. Some patients felt that earlier physiotherapy in hospital might have increased their confidence and enabled even earlier discharge.

Patients generally knew the staff who supported them but were often unclear about the formal role of the Early Supported Discharge team. The report suggested that greater awareness of the team's purpose might help patients feel more confident about being discharged sooner. 

Family members and unpaid carers were also largely positive about the service, particularly regarding the smooth transition from hospital to community services and the confidence the ESD team gave them. However, relatives were less positive than patients overall and sometimes wanted clearer information, more opportunities to ask questions, and greater involvement in discharge planning. Some carers said they would have benefited from additional guidance on helping patients safely at home. 

Results from the Friends and Family Test showed very high satisfaction, with 87% of respondents saying they were extremely likely to recommend the service and a further 7% saying they were likely to do so. Most written comments praised the quality of care, staff support, discharge arrangements, and home follow-up visits. A small number of negative comments related to equipment delays, limited support for people living alone, and transport difficulties for those without family support. 

Healthwatch Wiltshire concluded that the Early Supported Discharge service was delivering high-quality, person-centred care and helping patients return home safely and earlier. The report recommended maintaining the team's existing approach, improving communication about the team's role, considering earlier physiotherapy where appropriate, involving relatives more fully in discharge planning, ensuring the needs of patients without support at home are met, and continuing to improve coordination across hospital services.

The ESD team welcomed the findings and stated that they would use the feedback to strengthen communication and continue providing flexible, individualised support that promotes patients’ independence and confidence after discharge.