Behind the headlines

The prospect of fines for delayed discharges of older people
from hospital continued to be debated in the House of Lords this
week as the Liberal Democrats tried to postpone their introduction
until next year. Cross-charging has been opposed by MPs from all
three main parties including the Labour chairperson of the House of
Commons health select committee, David Hinchliffe.

During the third reading of the Community Care (Delayed
Discharges) Bill in the Commons, Hinchliffe said there had been no
support for the legislation to introduce cross-charging from social
services, health or voluntary groups. “It will damage the good
relationships between health and social services departments that
the government has created in some areas,” he said.

Liberal Democrat MP Paul Burstow said a system of fines between
local authorities and health trusts would “turn the patient into a
commodity to be haggled over by social services departments and the
NHS”. Conservative health spokesperson Simon Burns predicted that
older people would be given inappropriate placements.   

Bob Hudson, principal research fellow, Nuffield
Institute for Health, University of Leeds
“It is difficult to know who health secretary Alan Milburn
is listening to these days, but it certainly isn’t those who have
to deal with the consequences of his ideas. The reimbursement
proposal is a bad idea with potential to destabilise local health
and social care economies. He could win some much-needed respect by
having the courage to admit he has got it wrong, but humility does
not seem to be one of his stronger traits.”

Felicity Collier, chief executive, Baaf Adoption and
“The introduction through the Delayed Discharges Bill of a
consistent notification process of pending discharges and
measurement of waiting periods would signal real progress.
Performance indicators could then kick in. Fines are quite another
matter – will local authorities perform better if it hurts their
pocket? What a fiasco!”

Julia Ross, executive director for health and social care,
London Borough of Barking and Dagenham
“At the heart of cross-charging are some very basic
problems about working across boundaries which, despite strenuous
efforts in many parts of the country, are not being resolved. No
doubt cross-charging will solve some – though certainly not all –
of them. The focus on discharges delayed for social care reasons is
disguising a much more significant ‘bed-blocking’ of people waiting
for transfer to specialist facilities for medical attention. This
is far more likely to be the reason why waiting lists will prove
difficult to bring down even further.”

Bill Badham, development officer, National Youth
“The bed-blocking charge on social services may be matched
by fining hospitals for emergency readmissions on the basis that
patients had been discharged too soon. Instead of encouraging
social services and health to pull together, the government is
causing a tug of war, with the person needing care outstretched in
the middle. And so the budget tussle will go on until the best
interests of the individual are put first and care packages
transcend health and social services budgets.”

Martin Green, chief executive, Counsel and Care for the
“It is clear that the Delayed Discharges Bill is an
ill-thought-out piece of legislation that was formulated as a
knee-jerk reaction to a problem. The only positive thing that may
come out of this legislation is that local authorities may be
forced to increase what they are prepared to pay for long-term care
by virtue of the fact that it will be cheaper than a fine. This is
not the way that we should be managing the care of vulnerable

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