Pressure to avoid fines may force older people into unsuitable settings

Delayed discharge fines could force older people into accommodation
that does not serve their needs, according to two public health

Public policy professor Allyson Pollock and research fellow David
Rowland said last week that the rights of chronically sick and
older people to choose their own care home were likely to be
undermined by the new system, which came into effect this week.

Since October, hospitals have had to notify social services
departments of patients who may need social care on discharge. But
now social services departments will be charged £100 a day
(£120 in London and the South East) if they fail to arrange
care packages for patients within two days of being told of their

Writing in the British Medical Journal last week, Pollock
and Rowland, both from the school of public policy at University
College London, highlighted the dangers and pitfalls in the
Community Care (Delayed Discharge) Act 2003.

They warned that patients who exercised their right to choose – who
account for 8 per cent of delayed discharges – would be seen as an
obstacle to the “efficient functioning of the system”.

If their first choice of care home is not available, older people
may be offered an interim placement far from their family and

The Registered Nursing Home Association also warned that the
continuing loss of beds in independent nursing homes is likely to
leave some councils struggling to arrange patients’ discharge from
hospital in time.

Association chief executive Frank Ursell said that, although the
enforcement of delayed discharge fines could create a sudden rush
for places in care homes, it would be “unacceptably bad practice”
for the system to force older people into accommodation they did
not want.

He described the academics’ article as “scaremongering”.

– “Choice and Responsiveness for Older People in the Patient
Centred NHS” from 

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