New policy reduces waits but raises questions over care home referrals

Councils almost halved the extra time people spent in hospital
waiting for a care package in the three months after delayed
discharge rules were introduced a year ago.

A Commission for Social Care Inspection report found that councils
had generally risen to the challenge of offering a wider range of
care services more quickly.

The study is one of the first to examine the impact the
reimbursement policy has had on the discharging system since its
introduction in October 2003.

But the review of 151 case records and 70 service user interviews
in seven council areas found discharging practices varied.

The commission, which is refusing to name the poorest performing
councils in the study, found the number of people being discharged
directly into a care home varied from one in 25 in some areas to
more than one in three in others.

This suggests some social services departments, in their haste to
organise a care package within 72 hours, after which the NHS can
fine them £100 a day, are placing people in care homes instead
of developing intensive rehabilitation and intermediate care
packages to enable them to return home. The study found examples of
people being pressurised to enter care homes.

Of particular concern was the finding that, in some parts of the
country, half of patients are re-admitted to hospital within three
months of discharge, compared with one in 12 in other areas. One of
the main fears about the system since its inception was that it
could result in discharge before an adequate support package could
be put in place.

CSCI chief inspector David Behan said he was “heartened” by the
extent of good practice but warned greater emphasis needed to be
given to user experience. More follow-up work was needed to assess
longer term outcomes.

He said: “If health and social services are just concentrating on
rushing people out of hospital there is a real danger this will end
up dictating what will happen for the rest of their lives.”

The seven councils examined were Bournemouth, Cornwall, Lambeth,
Waltham Forest, Luton, South Tyneside and Sunderland.

l Leaving Hospital – The Price of Delays from www.csci.org.uk