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In Sheffield, a weekly improvement meeting with community health and social care staff sparked a discussion about assessing support needs for frail older patients after their acute care. An attendee questioned the relevance of assessing these needs in hospital settings, which differ significantly from patients' home environments. This prompted a therapist to propose a new approach: discharging patients directly to their homes and conducting assessments in real-time to better meet their care needs. A patient and their family agreed to test this method, and the following week, therapists reported on the outcomes, expressing initial skepticism about its effectiveness.