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Discharge to assess (D2A) pathway 2 team focus

3 care homes in Cornwall have been commissioned as places of care for people who are ready to be discharged from a hospital but need support to get back to the place, they call home.
The units in care homes are for people who need reablement or assessment in a 24-hour bed based setting known as discharge to assess (D2A) pathway 2. People who are transferred to these units are provided with up to 6 weeks intensive reablement to help them get back to living as independently as possible.

D2A is the national hospital discharge policy, which requires people to be discharged from hospital within 24-hours of a decision that they have been made medically better. People leaving hospital are allocated different routes of care dependent on their immediate needs, with the aim, where possible to get them home.

The units form part of the Embrace programme’s focus on temporary bedded care.

Meet Alex Dickinson
Alex Dickinson is physiotherapist team lead for D2A pathway 2.

Alex from Cornwall Partnership NHS Foundation Trust is one of a group of therapists practising in care homes. Their role is to work closely with hospital colleagues to get people back to independence quickly after a stay in hospital. Alex helped to set up the D2A reablement team in January 2021, having worked as a physiotherapist and discharge coordinator in London.

Alex tells us about 2 men he supported back to independence at Karenza care home in St Agnes.


78-year-old Michael is a leg amputee. He lives with his family in Mullion.

In December 2020, whilst recovering from a gall bladder operation, Michael was taken to Royal Cornwall Hospital with a hip fracture. He was there for 2 weeks before being transferred to the D2A pathway 2 reablement unit at Karenza care home in St Agnes. He was placed under Alex’s care.

Alex said: “Michael was very low, not exercising, just sitting in his chair, staring at the wall. He had spent Christmas in hospital and his 78th birthday was coming up, he wanted to get home to his family who cared for him.”

Alex gave Michael exercises and encouraged him to commit to them daily to build his strength. Michael’s daughter had brought him his ukulele, so, being musical himself, Alex spent time playing tunes with Michael which lifted his spirit.

Gradually Michael became more motivated and determined to get mobile and after a few weeks of dedicated hard work and country and western music renditions, Alex was able to discharge Michael on his 78th birthday. Michael enjoyed a belated Christmas and birthday celebration at home with his family.

Michael said: “When I met Alex for physiotherapy, I desperately wanted to get home to see my children and grandchildren, I was very low. Alex was full of enthusiasm and gave me hope that if I stuck to my exercises, I could get home. We had some fun times with my ukulele! I really want to thank Alex and his team for what they did for me.”

Michael is now happy back at home, and, although he has some ongoing struggles with his prosthetic leg, he is moving around independently and receives regular support from occupational therapy.


John is 92 and lives in Marazion. He fell at home late in 2020 breaking his hip. After a spell in hospital, he spent 6 weeks in the reablement unit at Karenza care home in St Agnes. John describes himself as fiercely independent and after his fall was determined to get home.

Alex worked with John to build his mobility confidence, providing regular exercises and charting his progress. John was appreciative of a chart with large letters so he could see how well he was doing and have a goal to getting home.

John says: “Alex and his team helped me to feel confident moving around on my crutches. I am now home doing better; I can make a cup of tea whilst on my crutches and I have had some equipment installed to help me shower and move around. I want to thank Alex and his team for giving me back my independence.”

Looking to the future

Alex is looking forward to building the team and helping more people. “We know that the longer people stay still in a hospital bed or without intervention in their homes when they need it, the more likely they are to deteriorate mobility and confidence. I’m excited about building this service to be able not only to support hospital discharges, but also help people who are struggling in the community. My job can be challenging at times, but I like to keep rehabilitation fun, ensuring everyone I look after is entertained and motivated to do their exercises If that involves a tune on the ukulele, I’m happy to add that to my repertoire!”

Keep up to date with news on integrated working across the Cornwall and Isles of Scilly health and care system, specifically the Embrace programme.

Added on 6 April 2021, in Case Studies - People’s stories

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