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- Today’s mental health insight: The (incomplete) picture of eating disorder performance
- Today’s announcement from the top: ICSs to be rated on safety, integration and leadership
Officially the final tranche of hospital discharge funding has been released, with integrated care systems asked for the first time to work to a capped budget for the last six months of the scheme.
The funding was first introduced in April 2020 in response to covid to help clear acute hospital beds. Since then, the government has announced that the funding will only pay for the first six weeks of care for people leaving hospital, dropping to four weeks between 1 July and 30 September when the current budget ends.
However, hospital chiefs are keen for this “game changing” funding pot to be continued beyond September 2021 as it has smoothed local relationships, increased discharges and reduced delays in medically fit patients returning home.
HSJ understands that NHS England is now pushing for the funding to become recurrent, but in exchange local systems will likely be asked to demonstrate its impact on length of stay and the extent to which it helps people become independent, reducing their reliance on social care after the funding package has ended.
However, concerns have also been raised that the new ICS discharge budget cap could see some clinical commissioning groups facing a “funding gap of between £2m and £5m” which NHSE expects to be covered by “core system budgets”.
Lou Patten, director of the ICS Network at the NHS Confederation, who made the warning, said she would welcome “an urgent discussion” with NHSE on this new financial burden.
Collaborations fail to stem crisis
The South East struggles with child and adolescent mental health services in normal times: it has relatively few NHS inpatient beds and has been dependent on private providers, of variable quality, for many placements.
But things now seem to have come to a head, with increasing demand during the recent stages of the pandemic combining with the closure of CAMHs units at two private hospitals. This has meant a dramatic rise in the number of children and young people who are waiting longer than recommended for admission to a tier 4 bed.
The number waiting for longer than specified has increased nearly tenfold since June last year, with an average of over 50 each week in the last few weeks that HSJ has seen figures for. They are likely to be waiting in a general bed or at home with community treatment – neither of which is ideal.
And while HSJ knows how many young people were waiting (thanks to the figures appearing in CCG papers – information on tier 4 services is a bit of a black hole), we don’t know how long each individual was waiting for after the decision to admit.
NHS England is legally responsible for commissioning these beds but has devolved this to provider collaboratives in many areas. Those collaboratives often involve the non-NHS providers in an area as well as NHS bodies – but it was the decision of two independent providers in Kent and Sussex to withdraw from CAMHs services which contributed to long waits for beds. Collaboratives may have many advantages but they don’t seem to have stopped services reaching crisis point in the South East.