Assessment and funding delays preventing hospital discharge for people with learning disabilities, finds study

Delays in completing assessments and agreeing funding are blocking the discharge of learning disabled people from hospital placements, a study has found.

The research, by psychiatric staff at Leicestershire Partnership NHS Trust, identified problems in the NHS continuing healthcare process that were leading to delayed discharges from inpatient units.

The study, which follows the government’s push to move people out of inappropriate hospital placements and into the community following the Winterbourne View scandal, examined the causes of delayed discharges in a 16-bed in-patient unit for people with learning disabilities.

Of 49 patients who received care in the unit from 1 February 2012 to 31 January 2013, 14 (29%) had a delayed discharge that ranged from 50 days to, in one case, over 900 days.

Half had their discharge delayed because they were waiting for assessments of their future care needs to be completed and an appropriate care setting identified, while four of the 14 were waiting for health and social care services to agree funding for residential or home care.

The study, published in the journal Psychiatric Bulletin, identified problems in the continuing healthcare (CHC) process that contributed to delays.

In some cases the decision support tool, used to help determine eligibility for CHC, had not been completed in a timely fashion, which delayed a decision on whether the NHS or social care should take responsibility for commissioning the person’s community care. In other cases there were delays in decision support tools being considered by CHC funding panels, while there were other cases when a CHC decision had been made but payments had not been authorised by other local authority or health funding panels.

It warned that delayed discharges “will continue to be a problem unless discharge processes are aligned between health and social care systems and appropriate placements are commissioned in the community”.

The study made several recommendations for reducing the volume and length of delayed discharges, including:

• Local authorities should allocate social workers to inpatient units so that social care needs are assessed from the point of admission;
• Health commissioners and councils should work together to develop community placements;
• The process of making funding decisions within social care should streamlined
• Patient advocates within inpatient units should challenge delayed discharges;
• Health and social care should make funding decisions together
• Key professionals should be appointed to coordinate care pathways for patients to facilitate their discharge.

However, the researchers admitted that there study was based on a small sample size in one local area, and recommended that more research was required that covered multiple areas.

The Department for Health has set a target of having all patients who are placed inappropriately in hospitals move into community placements by 1 June 2014.

In March NHS England figures dating from 31 December 2013 revealed that just 7% of those patients are due to be moved to community placements by the government’s deadline.