Discharge progress may falter

Progress made in reducing delayed discharge may be 'unsustainable', the chief social services inspector has warned.

Though the target reduction of 1,000 by 31 March was 'comfortably reached', future gains will be more difficult, Denise Platt said in her annual report, published last week.

And she said blaming delayed transfers on the actions or inactions of social services 'oversimplifies the situation'.

An analysis of the improvements highlights different levels of progress depending on the underlying reason for delayed discharge.

Ms Platt's report stated the greatest proportional improvement was in the area of people waiting for public funding, a situation relieved by the£300m cashfor-change money announced last winter.

But other factors - waiting for non-acute NHS care, waiting for a care home place and patients and carers preferring to wait for a place at the home of their choice - accounted for more than half of delays by the end of March.

Ms Platt noted that following the 'early wins' after the cash injection, 'agreement on local targets [for 2002-03] will be much more difficult to sustain given systemic weaknesses in markets in some parts of the country'.

The early gains 'may not be readily replicable without fairly radical shifts' in the way statutory bodies shape the wider care market, the report said. 'There is a risk without continuing focus and resource allocation that such progress will be unsustainable', particularly in areas with care home 'provider shortages' and 'increased activity and throughput levels in major acute hospitals'.

Ms Platt's report also warned that the emphasis on hospital discharge has left 'significant numbers' of elderly people who live in their own homes to wait for complex care packages.

It said organisational change in the NHS 'has continued to create problems for continuity of joint working in health and social care'.

See news focus, pages 11-12.