Hospital Discharge Grants for Carers

Please note: this is a one off grant for carers looking after residents living in the County of Leicestershire and is only applicable to hospital discharges from 3 February 2025.
Grant is not to be used for - Hospital visit, outpatients appointments, A&E visits or any other appointments which have no direct relationship with a period of overnight admission to hospital

Referrers details (if applicable - for health and social care professionals to complete only)

Your Name

Surname

Job Title

Place of work

Telephone Number

Email address

Has the carer consented to this referral? Y/N

Cared for Details

Title

Name

Surname

Date of Birth

Gender

Address

Postcode

Telephone Number

Hospital Discharge Details

Has the cared for been discharged from hospital in the last 2 weeks?

Yes

If No, please do not complete the rest of the form. For further advice please call Support for Carers on 01858 468543.

Date of hospital discharge

Name of hospital

Ward No.

Hospital address

NHS Number

GP and Name of surgery

Please provide evidence of hospital discharge for example: letter from hospital or other documentation

Carers Details

Title

Name

Surname

Carer date of birth

Carer Gender

Address

Postcode

Telephone

Relationship to the Cared For

Reasons for Hospital Discharge Grant

What conditions and support needs does the cared for person have?

What support are you - the carer, giving to the cared for person on their discharge?

What help and support do you require to look after the cared for person?

Consent to share information

The information you provide will be used for statistical analysis, management and reporting the provision of services provided by the county council and shared with VASL. The information will be held in accordance with the council's records management and retention policy.

Carer Declaration

I certify that the above information is a true record of my current circumstances and that I have not applied elsewhere for the hospital discharge grant. I agree that I will use the funding only for the services detailed on this application. I will retain receipts for 12 months for routine check purposes. If receipts are requested, I will provide within 10 working days of request.