Leaving hospital

If you go into hospital, you may be worried about what will happen when you leave.

Most people leave hospital and go directly back to their own home once their medical care has finished. Other people need extra support and therapy in their own home for a short time, this is called Reablement. Some may need ongoing long term support to be provided, either within their own home or within a residential or nursing care setting.

You shouldn’t be discharged from hospital until you are medically fit and appropriate assessments of your needs have been completed. This is all part of planning your discharge to ensure you get to your chosen destination/home safely with the right support.

The assessment(s) may be undertaken by a nurse case manager or a social worker from the Joint Hospital Discharge Team provided by Social Services and Aneurin Bevan University Health Board. Depending on your support needs, other professionals may also be involved, such as physiotherapist, occupational therapist, mental health nurse etc.

The Joint Hospital Discharge Team covers all of the hospitals where patients from Caerphilly County Borough are likely to be admitted, including:

  • Ysbyty Ystrad Fawr, Ystrad Mynach
  • University Wales Hospital, Cardiff
  • Prince Charles Hospital, Merthyr Tydfil
  • Royal Gwent Hospital, Newport
  • Neville Hall Hospital, Abergavenny 
  • And a number of other supporting community hospital in surrounding counties

You and your family/friends will be fully involved in the assessment process, and your views listened to. With your permission, any significant people in your life will also be kept informed and given the opportunity to contribute to planning your discharge. If you would like help putting your views across, an independent advocate may be able to help you with this.


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