Concern grows over penalties for delayed discharges from hospital

The social care sector has welcomed the
Budget’s 6 per cent increase in spending but is increasingly
concerned about proposals for penalties for delayed hospital
discharges.

Chancellor Gordon Brown said
social care will receive an additional £3.2bn between 2003-4
and 2005-6 – £800m of which has been previously announced and
planned for.

Health
secretary Alan Milburn also announced plans for a single
registration and inspection body for social care – replacing the
Social Services Inspectorate and the three-week-old National Care
Standards Commission – and financial incentives “to encourage the
take-up of care trust status” as well as other incentives to
encourage the use of legal powers to enable joint
working.

Milburn said much of the extra
cash would be spent on increased care home fees, with local
authorities facing penalties if they were responsible for delays in
hospital discharges.

Tony
Hunter, chairperson of the Association of Directors of Social
Services standards and performance committee, welcomed the headline
figures of cash increases in real terms, but added: “The issue for
us is how far the money will address the deep-seated financial
issues not only in services for the elderly but for children and
people with learning difficulties.”

Hunter
said local authorities had already surpassed the government’s
targets for reducing delayed discharges but faced problems because
of the financial difficulties experienced by private sector care
homes.

“The
success to date lies in joint working with our health colleagues,
and applying a punitive approach at this time is perverse,” he
said.

Public
sector union Unison welcomed the extra cash but said councils
needed time to rebuild care home capacity before penalties for
delayed discharges were considered. Unison’s national social
services officer, Owen Davies, warned that the proposals invited
the potential for “cost shifting” between the NHS and social
services.

But
NHS chief executive Nigel Crisp said the Budget offered the reforms
the sector had been asking for, including decentralisation and new
ways of strengthening partnerships with social services.

Rabbi
Julia Neuberger, chief executive of the King’s Fund, said penalties
for delayed discharge could lead to a reduction in user choice of
care packages. There were also concerns about patients being forced
to leave hospital too early.

Introducing financial penalties
for delayed discharge was one of the many recommendations of the
Wanless report into the long-term funding of the NHS, published
alongside the Budget last week.

The
report also highlights the dangers of the auditing process focusing
on specific targets rather than “performance in the
round”.

“Health and social care services
do not lend themselves to a small number of targets because of the
danger of mis-allocation of resources that would bring,” the report
says.