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Meg Munn MP - Sheffield Heeley's voice in Parliament | Welcome
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Meg’s thoughts on the Community Care Delayed Discharges Bill

Friday, April 11, 2003


For Care and Health Magazine Issue 30

Community Care Delayed Discharges Bill


Many people who work in social services view the measures for reducing delayed discharges contained in the Community Care Delayed Discharges Bill as punitive. Government Ministers argue that delayed discharges must be tackled in order to achieve a reduction in waiting lists in NHS hospitals. They also stress the harm that elderly people suffer when they languish in hospital - prone to infection with their mobility and independence threatened.

Bed blocking, as delayed discharges are commonly known, is not a new phenomenon - I first came across the term back in the 1980s during my social work training. In April 1993 the NHS and Community Care Act came into force, heralding new ways of working and a welcome shift to more community care for elderly people. I was a relatively new social services District Manager, taking on management of adult services for the first time. The next three years were some of the most interesting of my social work career. Over time we developed new services and improved integration between health and social services. Importantly, more elderly people were able to stay at home where they wanted to be.

Unfortunately performance was patchy across different social services departments. Some departments seized the opportunity to make lasting change to the benefit of all those involved, others did not. Too many replaced the previous arrangement of Social Security paying for residential placements with their own budget footing the bill. The opportunity to create modern care services to provide alternatives for elderly people was squandered.

As money grew tighter local authorities brought in strict eligibility criteria for assessments and services.  The recognition of the benefits of early intervention, of support to carers and the possibility of low level services keeping people at home for longer lost out to placements in residential and nursing care. Keeping people at home was more expensive in the short term - but with regular re-assessments care could be reduced and in the long term the cost would be less.


JUST DUE TO BAD PRACTICE?


Today from my Westminster office am I really saying that failure to get people out of their hospital beds is just due to bad practice? During the Conservative Government both social services and the NHS struggled to provide good quality services with the funds allocated. Payments to care homes remained low and with increasing numbers of elderly people the demand for care beds has grown. While local authorities reconfigured services to keep more people at home they were also often dependent on stretched health resources such as physiotherapy and occupational therapy.

Since 1997 additional funds have been provided and the increased flexibility introduced in 1999 for health service money to support social services was both right and welcome. Paradoxically, the additional money for the health service has helped them to treat more people, placing additional burdens on social services when its funding was not rising at the same rate.

Local authorities with their health partners have been required to draw up plans to reduce the number of delayed discharges. From October 2001 the Building Care Capacity Grant, amounting to £300 million by this March, has been available to support the development of services. In 2001/02 the target for reducing the number of delayed discharges was comfortably exceeded. In efforts to improve discharge rates increasing numbers of beds are being made available in intermediate care - services that provide the help and time for elderly people to regain mobility, independence and skills once they no longer need acute medical care.

Given the intense activity over the last 18 months and the progress made, do we really need reimbursement by social services for delays in discharge? While improvements have been made Ministers are concerned that it will not be maintained. The Health Select Committee’s report on delayed discharges published in the summer of 2002 reported wide regional and local variation in trends and this month’s National Audit Office report, Ensuring the Effective Discharge of Older Patients from NHS Acute Hospitals, also highlights ongoing problems. The Secretary of State for Health admits to have been influenced by this approach in Sweden and the Health Select Committee point to the USA, where significant change was achieved through a similar mechanism.

 

A STICK AMONGST CARROTS

There is no doubt that this is a stick but it’s a stick amongst a whole bunch of carrots. The Government are funding the expected cost through additional money which is in addition to an overall 6% increase in budgets. If social services departments continue to improve their performance the extra money can be used to further build the diversionary services. The Change Agent Team has been set up to assist local authorities with particular difficulties and there have been significant additional grants for community care.

 

Crucially, will it work? My own experience tells me that as a budget holder, if it was going to cost me more to keep someone in hospital than provide other services I would pay for other services. Some have said that this will be divisive, with greater tensions between health and social services. Where strong partnerships exist it is hard to see that this would be the case. All agree that a strong multi-agency approach is the best way to succeed, so this should be further encouragement where partnerships are weak. There is the danger of placing people in the most available rather than the most appropriate place, but this is not a new situation.

 

The introduction of community care 10 years ago was the right thing for elderly people; the problem was that each local authority was left to get on with it. This resulted in some using the time and money well whilst others did not. 10 years on, this government is taking a stronger strategic approach, demanding higher standards for the services providing elderly people with care and providing the resources necessary. For the Government to have one financial incentive putting pressure on social services to achieve the goal we all should be seeking - the right care, in the right place, at the right time - does not seem over zealous. This Government is committed to improving public services. Despite 10 years of community care and several years of additional funding, not all areas of the country are achieving what they could be expected to achieve. This incentive will make a difference.


 



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