Schemes to reduce the number of patients with a delayed discharge have been scaled back because commissioners can no longer afford to fund them under current tariff arrangements, trust chief executives have told HSJ.

  • Some trust have to take on costs of delayed discharge schemes
  • Commissioners unable to fund the schemes, trust chiefs say
  • ETO shifted cost burden for increases in emergency admissions to commissioners

Some acute trusts that signed up to the enhanced tariff option have been told by commissioners that they will have to fund schemes to speed up patient discharges themselves.

A number of trusts have taken on this cost, while others will have to scale back services because they cannot afford the cost.

Delayed discharges have been a focus for the government in recent months. Health secretary Jeremy Hunt, communities and local government secretary Eric Pickles and minister for government policy Oliver Letwin had been regularly discussing strategies for reducing delayed discharges.

Commissioners are feeling financial pressure partly because for years providers were reimbursed only 30 per cent of normal rates for increases in emergency admissions above 2008-09 levels. The enhanced tariff offer has raised this to 70 per cent.

However, this means the cost burden has been shifted to commissioners and they will only be able to hold on to 30 per cent of the payment rather than 70 per cent.

NHS England has promised a £150m fund for commissioners to cover extra costs under the ETO.

However, some provider chief executives told HSJ this is not enough to pay for all the schemes that were funded last year.

One acute trust chief executive said local commissioners had “tried to be bold” and fund an integrated discharge team to try and speed up patient discharges from hospital and avoid admissions. However, they have told the trust they can no longer fund the scheme.

The chief executive added: “The ETO is not enough to pay for the spend that has already been required - the big additional things regarding extra nurses following Francis, seven day working, plus with social services contracting [and] more patients with longer lengths of stay.”

Another chief executive said their trust’s winter pressure allocation for coping with accident and emergency pressures had been cut by commissioners, which could threaten the future of specific schemes introduced to reduce pressure.

In 2014-15 the total amount available for system resilience in urgent and emergency care for commissioners was £700m, compared with £400m for 2015-16. 

The chief executive for another trust said it would have to take on the cost of discharge to assess beds that were previously funded by commissioners.

A spokeswoman for NHS England said: “CCGs received an additional £1.1bn for 2015-16 following the December Autumn Statement and then an extra £150m on top of that as a direct contribution to the £500 million of extra funding that was available for providers who opted into the Enhanced Tariff.

“100 per cent of funding for these patients is within local health economy budgets. As part of the Enhanced Tariff proposals, the proportion of funding paid direct to providers has increased. Providers and commissioners will continue to work together to make sure the pathway improvements are sustained.”