Behind the headlines

The government has said that the plans to fine councils for the
delayed discharge of older people from hospital could be applied to
mental health and community settings. Earlier this year parliament
had voted to exclude mental health from the scope of the
legislation.

But in answer to criticisms about delays occurring in the discharge
of patients in community and mental health settings, the Treasury
has said in a report that “there is nothing to prevent assessment
and discharge notifications for acute care patients also being
extended to cover other care settings”.

The report maintains that there has been a reduction in the number
and length of delays in hospitals over the past two years.

New legislation came into effect in shadow form in October to make
hospitals notify social services departments about patients who may
need social care on discharge.

From 5 January social services departments will be charged
£100 a day – £120 in London and the south east – if they
fail to arrange the required care packages within two days of
notification. Bill Badham, development officer, National Youth
Agency

“Improved co-ordination across services is a good thing. But are
delayed discharge penalties popular with government because they
benefit the individual, or because they sound tough? What’s
important here is the health and well-being of the person receiving
care. This needs people power and practical resources and services
committed to the individual’s best interests, which is only
possible when individuals themselves are able to participate in
their own care planning.”

Julia Ross, social services director, London Borough of
Barking and Dagenham
“Reimbursement can help focus attention and effort on whole systems
working. However, what I’d really like to see now is acute
hospitals focusing on unblocking beds filled with cardiac patients
and others waiting for treatment, transfer, surgery or diagnostics
before it’s extended to other areas. Regretfully, some
opportunities have also been missed where it might have made more
sense for acute hospitals to invest in supporting social care
discharges, rather than sit back and wait for reimbursements to
kick in.”

Martin Green, chief executive, Counsel and Care for the
Elderly
“In principle I see no reason why the delayed discharge process
should not be extended to cover a range of client groups. My
problem with the delayed discharge legislation is not the notion of
fining local authorities, but a concern that the process might lead
to speedy and inappropriate discharge. What I would like to see is
some aspect of the quality of the discharge process being part of
the legislation and authorities being fined for a slow or poor
quality discharge processes.”

Bob Hudson, professor of partnership studies, Centre for
Health Services Management, University of Birmingham

“Things are getting to a low ebb when the practicalities of joint
working are determined by a dialogue between the Public Accounts
Committee and the Treasury! The fines regime is a bad idea in the
case of discharge from acute hospital, and it remains a bad idea in
relation to community mental health settings. Instead of imposing
penalties, the government should adopt a performance management
framework that rewards, rather than ignores, evidence of good local
partnership working.”

Felicity Collier, chief executive, Baaf Adoption and
Fostering
“Of course it is good news if more patients have been discharged
from hospital appropriately, on time and with proper support. But
we must remember how vulnerable mental health patients are and
careful analysis of reasons for delay for this client group must
precede any moves to impose penalties. There is still much concern
about the impact the fines will have and it is absolutely essential
we are allowed time to assess their impact before extending them.”