Social services look towards escape clauses to control bed-blocking fees

Social services departments could avoid paying hefty delayed
discharge fines by drawing up agreements with local NHS bodies that
would limit the number of referrals from hospitals.

A Department of Health official confirmed that a “good” local
agreement “should considerably reduce the charge” social services
would be expected to pay for not having a community package
available in time for a discharged patient. The deal would involve
the acute trust and primary care trust.

Charges would be reduced if hospital referrals to a social
services department exceeded those forecast by the acute trust when
drawing up the agreement.

Activity levels and the resources needed to meet them would be
set by social services and NHS organisations as part of the local
capacity planning process.

Agreements should also take into account local escalation plans,
which kick in when there is extreme pressure on beds, such as in a
flu epidemic. Again, it is likely that in such circumstances social
services would pay reduced fines.

From October, social services departments will be fined
£100 a day (£120 in London and the South East) for not
having a care package available within three days of notification
from a hospital that a client is to be discharged.

The system will run in shadow form for three months before money
starts to change hands on 1 January 2004.

Glenys Jones, chairperson of the Association of Directors of
Social Services, urged social services departments to set up local
agreements. She said it was a chance to “give us somewhere to go
other than overspend or delay”.

She said social services should talk to PCTs, strategic health
authorities and hospital trusts to establish peaks and troughs in
demand throughout the year, with the bill for fines potentially
being picked up by PCTs in some circumstances.

“If we don’t have that agreement, local authorities take
all the risk,” Jones said. “By doing this, we’re agreeing to
share the risk.”

The DoH official said agreements would also enable social
services departments to challenge plans by hospitals to increase
their activity levels if these exceeded the resources they had
available. Agreements could also establish where money generated
from fines should be invested.