Analysis of how delayed discharge fines will work

The Community Care (Delayed Discharges etc.) Bill was announced
in the Queen’s Speech and received its second reading in the
House of Commons on 28 November 2002.

The bill is intended to impose penalties on local authorities
who have failed to make arrangements for community care services
for people ready to be discharged from hospital, and makes
intermediate care and community equipment (minor aids and
adaptations in the home) free of charge.

Two of the explanatory notes to the bill explain the
background:

8. Currently, around 5,000 patients of all ages in England alone
are delayed on any given day in acute hospital beds when they are
ready to leave hospital. The majority are delayed because their
care needs have not been assessed or their package of onward care
has not been put together.

9.  In “Delivering the NHS Plan”, published on 17 April 2002,
the government announced its intention of reducing the number of
people who are ready and safe to leave hospital, but are unable to
do so, by introducing a system of reimbursement for delayed
hospital discharge.

This bill gives effect to that policy intention. It provides for
payment to be made to the healthcare provider per day of delay from
the point at which responsibility for an NHS patient’s care should
have transferred from the acute sector to social services. This
provides an incentive for social services to make prompt assessment
of a patient’s community care needs and make appropriate service
provision for them in timely fashion.

NHS bodies will be required to explicitly notify the relevant
local authority of individuals who they believe are likely to need
community care services upon discharge from hospital, and work with
them to assess a patient’s needs pursuant to section 47 of
the NHS and Community Care Act 1990.

This is to ensure that the recipient social services authority
can recognise this notice as the formal start of the process
provided for under this act.

The local authority will then have a number of days (to be
determined in regulations, although a minimum appears to be three
days) to put together a discharge plan in consultation with the
relevant NHS bodies, and determine which services it will provide
to an individual upon discharge.

Consultation is to ensure that a complete package of care can be
put in place smoothly and without duplication or omission of any
particular service.

There are two situations in which the local authority will be
required to make a payment to the relevant NHS body. The first is
where it has not succeeded in putting together a discharge plan for
an individual within the specified number of days. The second is
where a patient’s discharge has been delayed because (and
only because) the local authority has not been ready to provide
services to the patient at the specified time of discharge.

As to the amount to be paid the explanatory notes to the bill
state that the bill “also provides for regulations to
prescribe the amount of the charge which will apply per day of the
delayed discharge period, if the responsible authority does not
carry out its duties. This will be based on the average daily cost
of treating patients in a nursing-led facility with the costs of
medical input from doctors or specialist nurses, overheads and
capital removed”.

The bill also contains a regulation making power for local
authorities to provide certain community care services free of
charge. The community care services that will be prescribed in
regulations to be made free of charge will be intermediate care and
certain community equipment services.

Community equipment (also known as aids and minor adaptations)
is defined in the explanatory notes to the bill as “aids to
daily living to promote independence in the home, ranging from
walking sticks to grab rails and shower mats, predominantly
provided to older people and disabled people”. The loss of
charge income to social services has been estimated at £18.6
million.

Comment: Local authorities may well feel that
the bill unfairly lays the blame for bed-blocking at their door.
Often the reason for someone remaining in hospital is the lack of
appropriate care workers provided by agencies to provide services
in the home, or the lack of an appropriate care home placement.

There is bound to be increased pressure on social services to
carry out assessments quickly which, ironically, may well delay
assessments for community equipment which is now to be provided
free of charge, together with intermediate treatment.

Stephen Cragg

Doughty Street Chambers