Reflective Blog: Critical Thinking and Reflection in Addressing Discharge Dilemmas in Health and Social Care

(Nicoleta Sofronescu)

Health and social care professionals frequently face dilemmas that challenge their values, demand critical thinking, and require sensitive, ethical decision-making. One such dilemma is the premature discharge of vulnerable individuals from supported accommodation or care services, particularly when decisions are driven by resources rather than readiness. This reflection explores a scenario involving a young adult with a learning disability facing inappropriate discharge and how reflection and critical thinking can help professionals navigate the tension between organisational policy, service-user rights, and ethical practice.

The Scenario

A multidisciplinary team meeting is called to discuss the discharge of Jordan, a 23-year-old with a mild learning disability and social communication

difficulties. Jordan has been living in supported accommodation for the past 18 months after transitioning out of the care system. He has made steady progress in developing independent living skills, but continues to require support with budgeting, managing medication, and navigating social situations.

Due to funding constraints and increased demand for placements, commissioners are pressuring the service to move Jordan into semi-independent housing. This decision is met with concern by support staff and his keyworker, who believe the move could risk regression and place Jordan at increased risk of exploitation or isolation. However, the commissioning team argues that Jordan no longer meets the threshold for high-support accommodation.

Ethical Dilemmas and Reflective Thinking

This situation presents a classic ethical dilemma between organisational priorities and person-centred care. It raises questions about how readiness for independence is defined, who makes that judgement, and the risks of system-led, rather than needs-led, decision-making.

According to the Care Act 2014, decisions regarding care and support must promote individual wellbeing, independence, and choice (Department of Health and Social Care, 2014). However, when resource pressures come into play, practitioners may be forced to comply with decisions that appear to conflict with professional judgement or ethical standards.

Reflective thinking in this context is essential. As Schön (1983) highlights, practitioners must engage in ‘reflection-in-action’, questioning assumptions and re-evaluating options in real-time, especially when faced with moral uncertainty. The professionals involved in Jordan’s case must consider not just what is procedurally correct, but what is ethically responsible and sustainable for his long-term wellbeing.

Critical Thinking in Practice

Effective critical thinking involves the ability to analyse, evaluate and propose solutions. In Jordan’s case, this includes questioning:

• Is Jordan truly ready for semi-independence, or is this a reactive decision?

• What are the potential consequences of a poorly planned discharge?

• Are there alternative options, such as step-down support or increased community outreach?

• How can Jordan’s voice be heard in this process?

Involving Jordan in the decision-making process is crucial. The principle of empowerment, as outlined by the Six Safeguarding Principles (Local Government Association, 2020), insists that individuals must be supported to make informed choices. Too often, people with learning disabilities are excluded from meaningful participation, especially when decisions are made at system level (Goodley, 2011).

The team could apply a person-centred planning approach, ensuring Jordan’s wishes, fears, and aspirations are taken into account. Through supported communication and advocacy, Jordan might express concerns that professionals hadn’t fully considered — such as fear of being isolated or unsafe in a less supported environment.

The Role of Multi-Agency Collaboration

This dilemma also highlights the importance of interdisciplinary collaboration and assertive professional advocacy. Professionals, including social workers, support staff, and mental health specialists, need to challenge decisions that compromise care quality. As Thompson (2020) notes, critical practice involves being aware of structural pressures, but not allowing those to override ethical responsibilities.

A coordinated effort to present evidence-based concerns — such as risk assessments, behavioural observations, or previous transitions — could support the case for a delayed or phased discharge. In many cases, professionals can use legal frameworks, such as the Mental Capacity Act 2005, to argue that decisions made in the person’s best interest must consider their ability to understand and manage the implications of such transitions (Department for Constitutional Affairs, 2007).

Conclusion

This scenario demonstrates the complexity of ethical dilemmas in health and social care, particularly when institutional pressures clash with person-centred values. Reflection and critical thinking are not optional add-ons; they are fundamental to ethical and effective practice.

Professionals must be prepared to question policy-driven decisions, advocate for service users, and reflect on their own responses and biases. By doing so, they uphold the core principles of social justice, autonomy, and respect — even in environments shaped by austerity and limited resources.

References

Department for Constitutional Affairs (2007) Mental Capacity Act 2005 Code of Practice. London: The Stationery Office.

Department of Health and Social Care (2014) Care Act 2014: Statutory Guidance. London: DHSC.

Goodley, D. (2011) Disability Studies: An Interdisciplinary Introduction. London: SAGE Publications.

Local Government Association (2020) Making Safeguarding Personal: Principles of Adult Safeguarding. London: LGA.

Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.

Thompson, N. (2020) The Critically Reflective Practitioner. 3rd edn. Basingstoke: Palgrave Macmillan.