Fines have halved waits for discharge

The delayed discharge reimbursement system has halved waits for discharge and improved care according to its first major review, by the Commission for Social Care Inspection.

The report says that the new system has 'encouraged health and social care agencies to ensure an integrated approach to assessment of service delivery'. And it found that in the run-up to the introduction of the system, the amount of extra time people spent in hospital because their council could not arrange care almost halved between October 2003 and January 2004.

But the CSCI review, published this week, concludes that there are still pockets of bad practice.

It warns that patients should get as much choice at the point of discharge as at referral, and that their discharge options should not be based on what best suits inefficient local services.

The system, introduced in January, allows trusts to fine local authorities if patients have to stay in hospital because they are waiting for social services to arrange a care package. The CSCI report, Leaving Hospital - the price of delays, found that a minority of local authorities are sending older people into long-term residential or nursing home accommodation without proper assessment to avoid fines. The CSCI examined 151 anonymised cases and interviewed 71 patients across seven local authorities, ranging from zero to three-starred councils.

The report says the best areas - which HSJ understands includes City of Sunderland and Cornwall county councils - were able to focus on people's needs by offering them a full spectrum of choice across intermediate care and support in their own homes. Just one in 25 people went directly to care homes from hospital in such areas, the survey found.

This contrasts with more than one in three in the worst-performing areas. Half of the people in poorly performing areas were readmitted to hospital within three months, compared to one in 12 in areas where fewer people were being sent directly to care or nursing homes.

CSCI chief inspector David Behan said that, overall, reimbursement was working, but in some parts of the country there was still too much emphasis on process rather than people. 'There is a danger that this only looks at the shortterm options for people, not the longer-term outcomes, ' he said.

Mr Behan said the best-performing areas were able to excel because they invested money - given to local authorities ahead of the reimbursement policy's launch - in improving intermediate and home-care capacity.