Published: 12/09/2002, Volume II2, No. 5822 Page 5

Social services directors are set to call for£100 'fines' for delayed discharges to be paid to primary care trusts rather than acute hospitals.

Consultation on the government's controversial reimbursement scheme closes next week (18 September). It proposes that social services departments should pay£100 a day if they are responsible for the delayed discharge of elderly people from hospital.

The Association of Directors of Social Services is expected both to question the assumptions behind the cross-charging scheme and to propose that any introduction should be piloted and then phased in. ADSS vice-president David Behan said: 'There is no doubt there is a shared commitment that no-one remains in hospital who no longer needs to be there. One of the issues, though, is whether we think the system of reimbursement will achieve reductions in delayed discharges and consequently help with waiting lists.

The cross-charging scheme is based on a model used in Sweden, but critics have pointed to the different structure of health and social care there.

Mr Behan warned: 'There is evidence from Sweden that relationships deteriorated as a consequence of cross-charging. It would be a tragedy if progress on joint-working were to be arrested by concern about cross-charging.'

The ADSS is expected to urge that money from cross-charging be redirected to primary care, boosting its capacity to commission intermediate or rehabilitative services to help keep elderly people out of hospital.

Mr Behan also said the system should be piloted and phased in to acknowledge that cultural change and building support systems took time.

Social services directors are concerned about the three days allocated to put together a care plan for a patient's discharge, as proposed in the consultation document. Mr Behan suggested that 'seven might be a better target'.

NHS Confederation policy manager Janice Miles said the organisation was 'worried about what [the scheme] will do to relationships'.

'This seems to be counterproductive. I am not sure it will achieve what It is set out to achieve - reducing delayed discharges.

'We have not looked at the system in detail, but we suspect it will need some resources.'

She said the confederation, the ADSS and the Local Government Association would submit separate responses to the consultation but would probably issue a joint statement covering points of agreement.

The LGA is expected to maintain a harder line of strong opposition to the cross-charging policy, based on rebutting the premise that local government, rather than capacity difficulties, is responsible for delayed discharges.

It is also set to challenge the relationship between delayed discharges affecting medical beds and waiting lists for surgical beds.