Support After Hospital

Our Hospital Discharge Support team work alongside hospital staff to ensure that any patient aged 55 years old and older, can access the support they need to aid their recovery, regain their independence, and to improve their health and wellbeing.

Being in hospital was such a huge shock I didn’t stop to think how I would cope once I got home.


Possability People client

Following an initial home visit or telephone conversation with a member of our team to find out what help is needed we can then identify the services that can provide support and advice. Services such as:

  • home help and shopping provision
  • housing services and/ or care provision
  • disability and welfare benefits advice and advocacy
  • social engagement through accessible group activities
  • befriending
  • mental health and counselling support
  • re-ablement support to regain confidence and ability.

Although we are a short term service, we can provide support for up to two months following our initial contact with a patient. This is because we realise that gaps in support may not always be evident when a patient first gets home and as a patient recovers their priorities around support may change. The support we offer is always person centred and flexible to suit individual needs.

Who can apply for help?

Any patient who is:

  • aged 55 and over
  • is currently in hospital or has had a recent hospital admission (within the last 4 weeks)
  • is a resident of Brighton and Hove

How to apply for support

  • If a patient is in hospital, they can speak to a member of the hospital discharge team (such as a social worker, occupational therapist or clinician) and ask them to make a referral on their behalf.
  • If a patient has already been discharged home then they, their relatives or friends can make a self-referral into the service by contacting the team by phone or email.
  • If a patient or family member is worried about a future hospital admission and would like to know what support would be available when they return home they can contact the team for advice.

We also work closely with our Hospital Discharge Grant team to ensure patients who are eligible can access Hospital Discharge Grants  to make sure their homes are safe to return home to.

We are part of the Social Prescribing Network in Brighton and Hove.

84 year old Bernard was referred to our service because without a debit card, he was struggling to access his money and do shopping. Bernard had lost mobility since returning home from hospital and could only leave home in a wheelchair with someone to aid him.

Bernard didn’t know his Post Office account PIN number, but thought that if he could get to a cash point, he would remember it.  He had also run out of phone credit and couldn’t call anyone.

Our Hospital Discharge Facilitator organised an emergency food parcel for him through the Food Access Service. Bernard now gets nutritional advice through them too.

Bernard decided not to use the local Money Advice Service to help him access his money, so instead we linked him up with an independent home help, to support him to go to the post office in his wheelchair, top up his phone and do a weekly shop at his local supermarket, with his food delivered so he didn’t have to carry it.

Bernard asked his home help to stay out for a bit longer, so he could catch up with friends in his local café before going home. Bernard is over the moon that he is getting out and doing the things he used to enjoy. It is now a regular arrangement.

Another consequence of this new arrangement has been a marked improvement in Bernard’s mental health, noted by his physio therapist and social worker.

Contact us

If you need more information, contact our Hospital Discharge Support Service.

Telephone: 01273 069851