Contact: Lynn Waight Ext: 7265

1.0 Introduction

1.1 Reasons: This report supports Aim 1 of the corporate strategy (Maximising Life Opportunities) by contributing to the Older People Service Plan and the Older People Commissioning Strategy.

1.2 The Delayed Discharges (Community Care) Act was implemented in full on 5 January this year, following a three month shadow period. This piece of legislation requires acute hospital trusts to invoice social services departments at the rate of £100 or £120 per day for every delay in an acute hospital bed that can be attributed to a broad range of social care reasons as laid down by the Department of Health. Both elective and emergency patients are included.

1.3 It was stated in the Guidance that the object of the legislation is not to financially penalise and to establish perverse incentives, but to force health and social care partners to work together to improve whole system working.

2.0 Process

2.1 The shadow period did not accurately reflect authentic activity, but was an extremely busy time for all concerned. Nevertheless, implementation has been effected smoothly and the reimbursement process is gradually embedding into discharge practice.

2.2 The HCC-led Pan County Reimbursement Group has continued to meet and has a final meeting planned for mid-March. This group has been a forum for good practice and also provides local support where necessary. A representative from the Strategic Health Authority sits on the Group and has made a steady and helpful contribution to its function.

3.0 Operations

3.1 The five main acute sites with which HCC SSD conduct daily business have differing local strengths and weaknesses that have been highlighted since implementation.

3.2 Frimley Park NHS Trust have a very well developed patient education and choice policy which has proved helpful to the SSD team, for example by ensuring realistic patient expectations from (and sometimes before) point of admission. Circumstances at Frimley are good and partners are confident and equal in their working relationships.

3.3 Jointly funded beds (HCC/North Hampshire PCT) currently used for block interim placements and which have been successful in limiting fining liability, will no longer be available from 1 April and all three health and social care partners are working together to find and agree alternatives.

3.4 Winchester & Eastleigh Health Care Trust have approached the legislation with particular enthusiasm and the development of a demanding data base system. However, this has not prevented the HCC team from continuing to challenge and negotiate, with support where necessary. The departure of two key senior managers from this acute trust could affect future joint working.

3.5 Long standing SSD accommodation problems within the Southampton University Hospital Trust have been resolved with a short term solution which is on schedule to be in place by the beginning of next month. Mid and long term options are being discussed and provide an opportunity for all staff (health and two social services' departments) working on discharge to be located together. Historically this relationship has been low key and recent work has raised its profile to positive effect.

3.6 Portsmouth Hospitals Trust (two sites) continues to be an example of where there has been very good working relationships that have survived the bureaucratic and divisive challenges of the reimbursement regime.

4.0 Information

4.1 The systems for information collation both nationally and locally are adjusting to the different needs of the new ways of working.

4.2 There was an assumption that once the Department of Health `sitrep' definitions were realigned in late November, all acute social care delays would be automatically `reimbursable' - this is not the case and has been the root of some confusion, both on acute sites and also at the Strategic Health Authority. A joint (i.e. equal responsibility given to each partner) information system would eliminate the majority of problems, and discussions have begun regarding this, although it would be a long term action which could be driven by S.A.P (National Service Framework requirement - Single Assessment Process).

4.3 Several weekly reports are produced of the overall County perspective. The information is duly analysed by SSD HQ and disseminated to relevant managers. At the time of writing, week ending 30.01.04 shows 29 acute social care delays (of which 20 delays were reimbursable) and 166 whole system delays. Whole system figures include social care, health and jointly attributable delays and have not reduced in ratio to the social care reductions.

4.4 The average expenditure per week on fines for the first five weeks of reimbursement has been £6,600 per week. If we look back to January 2003 and use a similar trend pattern, the average spend on fines per week would have been £45,000. This once again demonstrates the very significant reductions achieved in social care delays over the last year.

4.5 Since the first week it has been a general trend that the reimbursable delays will be approximately two thirds of the total acute social care sitreppable delays. Until a formal review of whole systems delays takes place, it is not easy to analyse the remainder.

4.6 Summaries of whole systems delays continue to be sent out a week in arrears by the Department of Health; a more responsive method is needed to be able to address problems.

4.7 The County spreadsheet has been adjusted both in codes and content and now contains reimbursement information as well as sitrep information. It needs further work, but will be fit for purpose by the middle of next month.

5.0 Future

5.1 There have been several highlights from the shadow period and the first six weeks of the new regime as follows:

5.1.1 Some health partners genuinely wish to use the legislation to improve discharge procedures for patients/clients. Others wish to use it to bolster funding deficiencies in their economies. It is difficult to meet both intentions with an equal response.

5.1.2 HCC staff have worked hard to reduced social care delays. They work in a pressurised and difficult environment on a daily basis - their continued effort is vital to maintaining this reduced level of delays.

5.1.3 Whole systems delays continue to affect Hampshire residents and there needs to be a shift in national focus so that improvements on these figures are driven from the centre.

5.1.4 HCC service users' interests need to be kept at the forefront of the process and every effort should be made to ensure that person-centred care is delivered both during and after a hospital visit.

6.0 Recommendation

That the report be received and noted.

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Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1 Published works.
Documents which disclosure exempt or confidential information as defined in the Act.