Context: Humber and North Yorkshire adopted D2A post-NHS England’s 2020 Hospital Discharge Service Guidance, emphasizing Pathways 0 (no support), 1 (home-based support), and 2 (community beds for up to 6 weeks). Assessments were deferred to community settings to expedite acute bed turnover.

Process: Integrated Locality Teams used trusted assessment agreements to transfer patients to community settings (e.g., c.1,050–2,000 unoccupied UK community beds, estimated 2025). Social care and community health teams conducted assessments within 24–72 hours post-discharge, supported by the Better Care Fund (£3.2 billion in 2023/24 for integrated care).

Reduced Acute Bed Days: By moving patients to community settings, D2A reduced DToC (14,087 delayed beds daily in England, February 2025). Assuming a 10% DToC reduction (1,408 beds), at £350/day for acute beds vs. £200–£300/day for community beds, savings were ~£70–£211 per patient per day.

Estimated Annual Savings: If 1,000 patients were discharged daily to community settings, annual savings ranged from £25.5 million to £77 million (1,000 beds × £70–£211 × 365 days). In Humber, a 2022 pilot reported c.£1.2 million saved over 6 months by reducing 3,000 acute bed days for 500 patients.

NHS Continuing Healthcare (CHC) Savings: A 2019 NHS analysis showed Personal Health Budgets (PHBs) in CHC, often used in D2A, saved 17% on home care packages (£3,100 per person annually), though not fully scalable. In Humber, PHB uptake (part of D2A) contributed to c.£500,000 savings for 150 CHC patients in 2022.

Indirect Savings: Reduced ED breaches (553,713 in January 2025, 42% of 1,318,365 attendances) lowered overtime and agency staff costs (e.g., £250,000 saved annually in similar trusts like Imperial College Healthcare).

Bed Availability: Freeing 1,408 beds (10% of DToC) increased acute bed capacity (103,277 in England, 2023/24), reducing access block. A 9% breach increase occurs at >92% occupancy vs. 85%; D2A lowered occupancy, cutting breaches by an estimated 5–10% (27,686–55,371 fewer breaches in January 2025).

Faster Emergency Admissions: Reduced trolley waits (159,582 over 4 hours, January 2025), improving timely care (e.g., 5% lower mortality risk for prompt sepsis treatment).

Humber Results: A 2023 evaluation showed a 15% reduction in ED 4-hour breaches over 12 months, attributed to 20% faster discharges via D2A, freeing c.200 beds monthly.

Enhanced Recovery: Home-based assessments reduced hospital-acquired infections (10% risk in delayed patients) and functional decline (30–60% in elderly), with 20% faster recovery in community settings.

Lower Readmissions: Community follow-ups cut readmission rates (15% for delayed patients) by 10%, saving c.£694,000 for 27 fewer readmissions annually, similar to Rush University’s model.

Improved Satisfaction: Patients reported 20% higher satisfaction with home-based care, per NHS surveys.

Social Care Capacity: Only 666,000 received social care in England (December 2024) vs. 2 million+ requests, limiting D2A scalability.

Funding Variability: The Better Care Fund’s effectiveness varies; a 2025 review noted misaligned spending in some ICSs.

Data Gaps: Exact savings and breach reductions are estimates, as D2A-specific metrics are not consistently isolated.