Published: 01/08/2002, Volume II2, No. 5816 Page 12 13
Streamlining the assessment procedures for older people's care needs will have a positive knock-on effect for delayed discharge.Carol Harris reports
Improvements in the time taken to assess and supply equipment are key to the success of new developments in elderly care proposed by health secretary Alan Milburn and the Commons health select committee last week.
In a speech to the Commons last Tuesday, Mr Milburn said: 'We will guarantee older people faster assessment of their needs.Reforms are already in train to bring local health and social services together and to ensure that they provide a single seamless service.'
He also promised that people will be able to choose whether to have services provided through their local authority, or to buy services themselves from a range of sources with a cash sum.
Detailing the changes, health minister Jaqui Smith told journalists: 'Local authorities have had the power, but not the obligation, to offer cash payments. Now they will be required to do so.'
Help the Aged policy officer Gail Etherington says that the discretionary system has operated successfully for disabled people and elderly people in some parts of the country, but other local authorities have been reluctant to hand over financial control to clients.
'Direct payments are a great idea for clients and we welcome the new rules taking away the local authorities' discretion.' She adds: 'But it feels to me that this is a tough target on assessments.'
By 2004, assessments will begin within 48 hours of contact with social services and be completed within one month. Equipment and services requested will be supplied within one week.
The day after Mr Milburn's statement, the health select committee called for major changes in assessment and supply of equipment to alleviate delayed discharge in the NHS.
But meeting the new time limits depends in part on increasing the numbers of occupational therapists to carry out the work. OTs are currently in very short supply in the NHS and in social services.
Ms Smith claims that the additional OTs required are within the extra numbers detailed in the NHS plan.
Simon Burns, MP for Chelmsford West and a member of the health select committee, says that in view of persistent OT shortages, nurses are the best professional group to take on the assessment role, though 'assistants, with suitable training, could do the work too'.
'I can't see the problem with that - though perhaps others can.'
The College of Occupational Therapists angrily dismissed the committee's assertion.
'We have been hearing for years that if there are not enough OTs, other people should be involved.
But who are these other people within the system who have time on their hands, ' COT chief executive Sheelagh Richards asked.
The health committee report recommends that discharge procedures should be a priority element in clinical governance, and of every Commission for Health Improvement review in the NHS.
Mr Burns believes that imposing fines on local authorities that are responsible for delayed discharges will be crucial to the operational success of the scheme.
'We may well see a speeding-up of the process for leaving hospital, because if that does not happen, the fines come into effect. This data can be collected daily, and so it should be quite straightforward to go through and pick out areas where delayed discharge is due to the problems we identify and action is taken to remedy it.'
The health committee had visited Boston and Vancouver to look at discharge policies.
The report itself says of the US approach: 'Obviously it was in the interests of a medical insurer to minimise the length of hospital stay, but we were struck at how this financial imperative could also act in the patient's interest.'
Closer to home, the team visited Berryhill care village in Stoke-on-Trent (see box). The committee recommends that the Department of Health closely examines facilities at Berryhill and conducts a cost-benefit analysis to compare it with the costs of hospitals stays and other forms of care.
'We are concerned that too much effort is being put into developing 'more of the same', with insufficient attention being paid to focusing on the appropriate care for people, and developing the necessary alternative service models to ensure the right care in the right place at the right time is available, ' says the report.
Mr Burns says the government has three months to respond to the report and that the health secretary will be appearing before the committee shortly after that deadline, which puts added pressure on the government to ensure that progress is made.
There is a realisation 'that something must be done, but we will have to wait and see how successful the proposed measures are in the light of shortages [of OTs], ' he says. l Key features of the package for older people l All older people to be offered choice of direct payments to purchase services from variety of sources.
Faster assessment and supply of equipment.By the end of 2004, social services to assess within 48 hours of the request being made.Assessments to be completed in one month.Equipment to be supplied within one week.
£70m to be spent on training for social care staff.Local authorities will be able to pay higher fees for care homes.
By 2005, increasing the number of intensive home care packages to double that of 1995.An extra 70,000 rehabilitation packages and 50 per cent more care housing places to be provided.Fifty per cent increase in extra care housing places.
Half a million more items of free community equipment.
Carers'grant to be doubled to£185m by 2006, providing respite care and breaks for an additional 136,000 carers.
Recommendations: select committee report
Term 'blocked beds' rejected; 'delayed discharge'preferred.
Department of Health data shows reduction in delayed discharge rate for patients over 75, from 15.7 per cent in 1997 to 12 per cent in 2001.Committee notes wide regional variations but also queries reliability of data.
Authorities responsible for delayed discharges to be fined.
Multi-agency team to manage discharge, led by patient discharge liaison manager appointed jointly by health service and local authority.
Named person to co-ordinate patient's journey to and beyond discharge.
Discharge procedures to become a key element in clinical governance and every Commission for Health Improvement review.
Capacity-building to provide more places in variety of settings risks feeding problem and is not the answer.
Committee estimates net loss in long-term care and care home places between 1997 and 2001 to be 34,200.
Other health professionals to be trained to compensate for occupational therapy shortages which delay assessment.
Cost benefit analysis of schemes which emphasise healthy and active living in older people.
DoH must publish examples of good practice and collect more detailed data.
Model village Berryhill care village in Stoke-on-Trent (pictured) was opened in 1998 and has 148 purpose-built flats, each with the usual aspects of sheltered accommodation, such as warden call-alarm systems, easy-to-use taps and switches and wide door access.
Facilities include a shop, gym with sauna and jacuzzi, computer rooms, library and hair salon.
Berryhill is run by charity Touchstone ExtraCare.Every Berryhill resident has an individual support package developed with his or her key worker.The aim is to support changing needs so that residents can stay at Berryhill rather than move on to a specialist care unit if their needs change.
Key workers are central to the smooth running of the system and the team is on call 24 hours a day.All key workers are trained at least to NVQ level 2 within their first year.
Delayed Discharges . House of Commons health select committee. The Stationery Office,£13.
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