Prompt discharge of patients is vital when beds are scarce, but some patients may need continued care to help them adjust. Diane Evans describes a voluntary scheme to help frail patients who live alone

Being discharged from hospital can be a long drawn out, stressful process, particularly for patients who live alone. Once home, the patient may feel insecure, frightened and vulnerable.

From the hospital's point of view, delays in the discharge process mean extra difficulty in finding beds for new admissions. Discharge procedures are an important factor in effective planning for winter pressures.

Royal Liverpool and Broadgreen University Hospitals trust has solved part of this problem by introducing a buddy service of volunteers who accompany patients home, using hospital taxi or the British Red Cross transport service.

The service was developed by a steering group, comprising the volunteer co-ordinator and assistant co-ordinator, the discharge co-ordinator and discharge suite co-ordinator, the quality facilitator, district nursing liaison officer and social services.

The legal department was involved in devising indemnity forms, allowing the 'buddies' access into patients' homes and handling money to buy essential provisions.

It was agreed that all patients using the service must be mobile, requiring minimum assistance when entering and leaving the vehicle.

Patients suitable for the service are identified by the staff of the discharge suite.

The pharmacy prioritises patients in the discharge suite when preparing medication to be taken home.

The British Red Cross provides a vehicle and volunteer driver to escort the patient and volunteer.

If the British Red Cross is unable to provide a service, the patient and volunteer travel home by hospital taxi.

On arrival, the volunteer settles patients, makes them a hot drink and sandwich and, where necessary, shops for essentials.

The volunteer may stay up to an hour and, once the patient is settled, will return to the hospital and report back to the volunteer co-ordinator on future needs.

If the volunteer reports that the patient needs more support, the British Red Cross Home from Hospital scheme is contacted.

They are able to provide up to four weeks' support with shopping and general companionship. The service was piloted in five general medical wards in November and during the second week the scheme was extended to all wards in the hospital.

During the four-week study, 23 patients used the service. Most were women over 65 and all thought the service improved their return home. They commented that it made the discharge process smooth and stress-free. 'Far better than before, when you waited on the ward for tablets for hours, then even longer for an ambulance, ' was one comment.

One patient appreciated the hospital taxi stopping on the way back for milk and bread. All said they would use the service again, if offered.

Volunteers had helped with shopping in many cases.

The buddy service now forms part of the trust's winterpressures initiative and is jointly funded by Liverpool health authority and Liverpool city council.

Together with the British Red Cross, the trust is developing a quality discharge 'home from hospital' service.

They are forging greater working relationships between acute services and community services within the city of Liverpool.

The trust believes this is very much within the spirit of the NHS plan and its intention that older people should not be left in hospital when they can safely be cared for at home.

The number of patients using the service has quadrupled since the pilot. There have been many referrals from the social work department. There are plans to extend the service to escorting patients from intermediate care beds back to their home, and the British Red Cross is training six volunteers as drivers, to reduce reliance on hospital taxis.