Anti-trespass laws to be used to shift bed blocking patients

NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements.

If a patient still refuses to leave, the hospital could seek a court order for possession of their bed.

A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.

This was the legal principle which allowed shopping centres to ban youths wearing hooded tops, the source added.

NHS Sefton developed the plan with Aintree University Hospitals Foundation Trust and Southport and Ormskirk Hospital Trust because nearly all “delayed transfers of care” on its patch resulted from patients with “outstanding care needs” refusing transitional placements.

“Delayed transfers of care” refer to patients who have been deemed fit for discharge but have not left their bed due to alternative community care arrangements not being in place, or not being to the agreement of the patient and their family.

A spokesperson for the primary care trust and both providers said the approach was supported by trusts across north Merseyside, and in the final stages of agreement.

She added: “Taking legal action to move a patient from hospital into a care home would always be a last resort. It could only be considered after every other available option had been thoroughly explored with the patient and their family.

“However, the NHS has a duty to ensure hospital beds are available for those who are seriously ill and not occupied by people who no longer require acute consultant care.”

Between July and September Sefton had 7.3 delayed transfers of care per 100,000 members of the adult population, against a target of three.

The legal source said the precedent for Sefton’s approach was a 2006 case, in which NHS Barnet obtained a High Court possession order against a patient who had remained in hospital for nearly three years after being declared fit for discharge.

The source said there was no reason why the precedent could not apply to shorter discharge delays.

The Barnet patient was also ordered to pay £10,000 towards the PCT’s legal costs.

Older people’s charity Age UK said there were better approaches to the problem than “threatening court action to turf people out of hospital beds”.

Age UK charity director Michelle Mitchell said: “This proposed treatment of vulnerable, frail patients by a primary care trust is extremely heavy handed and very concerning.  It appears to be a very blunt tool to fix what looks to be a far more complex problem.”

Ms Mitchell said if patients were refusing placements there was “clearly an issue with the discharge and care arrangements” offered and the PCT needed to “work with the local authority to get to the root of the problem”.

It might be that these placements are far from family, or that patients fear their placement will not really be “transitional” and they will be stuck in a supposedly temporary place, she suggested.