Faster and fitter

Despite the brouhaha surrounding the introduction of delayed
discharge fines a year ago, the evidence is that they are working.
This week’s report from the Commission for Social Care Inspection
contradicts the pessimists who said the reimbursement policy for
hospital discharges taking longer than three days would be a
needless distraction. On the contrary, the policy has concentrated
minds on drawing up effective care packages, an achievement which
probably outweighs the occasional complaint that it skews
priorities at the health and social care boundary.

Faster discharges do not appear to have come at the expense of
imaginative care packages. By the start of this year councils had
almost halved the excess time older people were spending in
hospital waiting for care to be arranged.

But performance around the country is still mixed, with some
disturbing variations in user choice and in rates of readmission to
hospital. In some areas care homes are a Hobson’s choice for
patients, either because short turnround times give little scope to
creative thought, or because scant attention has been paid to
cultivating alternatives. As choice becomes the 10 Downing Street
watchword, these failings will be increasingly untenable.

The dramatic contrasts in readmission rates hark back to some of
the lurid claims made in the early days of the policy. Then it was
alleged that older people’s lives were being put at risk in the
rush to push them out of hospital. Evidence of any calamities has
been hard to find, but there is something wrong when in some parts
of the country half of patients have to go back into hospital
within three months of leaving it, whereas elsewhere only one in 12
are readmitted within this time. In a few cases these readmissions
may be part of a sustainable care package that delicately balances
hospital and home care. But in many cases, readmissions are
evidently not of this kind.

It is clear that care services in some areas remain antediluvian.
The government’s forthcoming vision for adult social care will, if
it does what it promises and focuses on people’s needs, spur the
development of modern services everywhere.