Directors’ alarm at idea of delayed discharge fines for mental health

The system that fines councils for delayed discharges from hospital could be extended to mental health despite “strong reservations” among social services directors.

Since April, mental health trusts have had to collect information on the numbers of delayed discharges, and some directors fear is the prelude to the introduction of the reimbursement scheme.

The Department of Health held an informal consultation on the issue from September 2005 to February 2006 but this week it said it was yet to make a decision.

Jenny Goodall (pictured), joint chair of the Association of Directors of Social Services’ mental health strategy group, said: “We have expressed strong reservations but we haven’t heard whether they would be taken account of.” She said people saw the recording of delayed discharges by mental health trusts as a first step.

The Community Care (Delayed Discharges) Act 2003, which introduced the system into acute hospitals, allows for the extension of reimbursement to mental health, with parliamentary approval.

However, Goodall said there were key differences between its application to acute hospitals (see box), which preceded a significant fall in bed-blocking, and mental health.

The fact that most mental health services were delivered through multi-disciplinary teams meant that social care could not be solely responsible for delays.

She added that the success in acute care had been down to councils’ delayed discharges grant but the DH had indicated there would be no new money for mental health if reimbursement is implemented.

But in a report last week, the Royal College of Psychiatrists said reimbursement could improve the care of older people with mental health problems.

A DH spokesperson said: “We have asked mental health trusts to record delayed discharges to get a picture of where the problems are and where good practice is. It will feed into [the consultation].”

Reimbursement for delayed discharges
Since January 2004, councils have been liable for fines, payable to acute trusts, for each day a patient remains in hospital because of the unavailability of social care.
Since 2003 they have been given £100m a year to invest in services to prevent delayed discharges, such as intermediate care.
From 2003-4 to 2004-5, the average number of weekly delayed discharges fell from 3,600 to 2,700.

Contact the author
 mithran.samuel@rbi.co.uk