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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views

Delayed transfers of care

The draft regulations and guidance focus on those NHS hospital patients who have been receiving acute care and whose discharge from hospital is unlikely to be safe without some care and support input.

Of course, good and safe discharge planning applies to all patients, as do broader legal duties to ensure this happens. However, the statutory provisions relating to reimbursement apply specifically to transfer of care from NHS hospitals to local authority care of patients with care and support needs, which can be measured in a fair way and which has historically been an issue.

The regulations set out the details of the notices which the NHS body responsible for the patient must contain to ensure the local authority complies with its requirements to undertake assessments and put in place any arrangements necessary for meeting any of the patient’s care and support needs. This means that if the local authorities do not comply with the requirements set out in the regulations and a delay occurs to the patient’s discharge, then the local authority may become potentially liable to pay a reimbursement to the relevant NHS body for such a period and at such an amount as set out in the draft regulations.

The draft Care and Support (Discharge of Hospital Patients) Regulations 2014, cover:

  • processes and requirements relating to delayed discharges from hospital for NHS acute care patients with care and support needs
  • the period and amounts of any delayed discharge payment

See also:

Annex G of the draft guidance: The process for managing transfers of care from hospital

We have largely carried forward the effect of the existing delayed discharge regulations in these new regulations. However, there are areas where we have amended current provisions. The key changes are shown below.

For those delays, which are recorded as being attributable to the local authority, the NHS is no longer obliged to seek reimbursement. This is intended to reinforce the need to focus on joint working at a local level as a way of reducing those days attributable to the local authority, with the expectation that reimbursement generally would only be asked for by the NHS as a last resort.

In keeping with the expectations that both the NHS and the local authority should be operating on the basis of a 7-day model, the regulations remove weekends and bank holidays as being exempt from reimbursement.

To reflect that there has been no increase in the reimbursement rates since 2003, the updated regulations increase the proposed discretionary reimbursement rates by the Consumer Price Index measure of inflation since 2003. This means an increase for local authorities outside London from £100 to £130 and for London authorities from £120 to £155.

The purpose of making this increase was to reflect the fact that there has been no increase since 2003, without increasing the amount to a level that would encourage an increased use of reimbursement. We have reduced the scope of those local authorities covered by the higher rate to only London authorities to reflect the acknowledged increased cost base that there is in comparison to other areas of the country.

The updated regulations require that the Assessment and Discharge notices include the patient’s NHS number. In addition, to facilitate an effective joint working relationship between the NHS organisation and the local authority, the contact details (ie email address or telephone number) of the person at the hospital who will be responsible for liaising with the local authority will also be required for these notices. This is intended to address concern that the 2003 regulations only require the name of the person, and there are concerns that this means in some cases locating where that person is can or how to contact that person can cause a delay.

Question 51: Will any of these changes affect the working of delayed discharge processes in ways not discussed in the guidance?

Read: guidance on integration, co-operation and partnerships The Care and Support (Discharge of Hospital Patients) Regulations 2014 Back to delayed transfers of care

Question 52: Can you provide any best practice examples or guidance relating to hospital discharge for people with care and support needs?

Read: guidance on integration, co-operation and partnerships The Care and Support (Discharge of Hospital Patients) Regulations 2014 Back to delayed transfers of care

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