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The Community Care (Delayed Discharges etc.) Act today completed its ...
The Community Care (Delayed Discharges etc.) Act today completed its

progress through parliament. The Act introduces a system of

reimbursement for delayed hospital discharges and removes local

authorities' ability to charge for community equipment and

intermediate care.

Following parliamentary debate, the government has agreed to

staggered implementation of the reimbursement system. The new duties

placed upon the NHS and local authorities relating to the discharge

of patients will start in October 2003. However, councils will not be

charged for delays, which are their responsibility until January


Health minister Jacqui Smith said:

'We are pleased that this legislation has been passed. We have

already made a great deal of progress in reducing delayed discharges,

but it is not just about reducing the numbers. We are committed to

providing people with the right care, in the right place and at the

right time. Tackling delayed discharge will help to ensure that

services are tailored to meet people's needs rather than the other

way around.

'We have reached a compromise, which we believe goes a long way to

maintaining that impetus and also gives councils an additional #50m

to use this year.

'This will be paid as soon as practicable so that councils can invest

these extra resources in expanding older people's services, and

minimise any charges for which they may become liable in January.

They will have a three month period over the winter to prepare

alongside their NHS partners, with support from the Department of

Health, for full implementation of the new system.'

Key Points:

The Act places a duty on NHS trusts to notify local authorities as

soon as it becomes apparent that a patient in acute care may require

community care services upon discharge. Local authorities and the NHS

are required to work together to determine the services that an

individual needs;

It creates a s trong financial incentive for local authorities to

assess individuals who are in hospital and make provision for any

community care services that they may need, as quickly as possible.

This means that more people will be in the most appropriate care

setting for their needs;

It promotes the independence of older people by creating incentives

for them to be transferred from an acute ward (where they are at risk

of losing their independence) to a more appropriate community setting

as soon as they are ready for discharge; and

It means that community equipment (aids to daily living such as

walking sticks and shower chairs) and intermediate care

(rehabilitation care provided in a variety of settings) provided by

local authorities will no longer be charged for and will now be free

to users, simplifying the existing system and making it more

user-friendly. This also makes it easier for PCTs and local

authorities to work together to provide these services more

effectively through a pooled budget.


1. The Bill received Royal Assent on 8 April. From January 2004 the

scheme will operate in full, providing a financial incentive for

councils to promptly assess and arrange community care services for

patients leaving hospital. The provision removing social services

ability to charge for community equipment aids and intermediate care

services and to make these services free of charge to users will be

implemented as soon as possible after Royal Assent.

2. In November 2002, secretary of state announced that £100m would be

transferred from the NHS to local authorities for each full year of

the scheme's operation to help councils in tackling delayed

discharges. Despite the postponement of the charging element until

January 2004, health minister Jacqui Smith has confirmed that

councils will receive £50m to cover the whole second half of the

2003-4 financial year.

3. This additional £50m will be made available as a specific formula

grant during the first few months of this financial year in order to

give local authorities time to invest their allocations before

January and for those investments to take effect. The Department of

Health will be consulting on the distribution of this grant shortly.

4. The intention to introduce a system of reimbursement was announced

in 'Delivering the NHS Plan' in April 2002 and is based on a system

used in Scandinavia that has had a major impact on reducing delayed


5. The government is committed to ending widespread delayed

discharges by 2004 and investment and reform of older people's

services over the next three years will help to achieve that.

Following the distribution of the £300m Building Care Capacity

Grant to Local Authorities in October 2001, much innovative work has

been carried out with the NHS, social services, independent and

voluntary sectors working together to reduce the number of people

over 75 who are stuck in hospital.

6. To further support this work, the Department of Health is

launching the Access and Systems Capacity Grant. This will provide

£170m to local authorities in 2003-4 to build up community based

social care services, help more older people live at home, and

contribute to reductions in delayed discharges.

7. Social services will receive in real terms an annual average

increase of 6% increase over the next three years. By 2006 older

people's services will receive an extra £1bn a year to expand

home care services, extra care housing, community equipment, services

for carers and intermediate care.

8. With the extra funding councils will have the resources to put in

place the volume and range of services needed to provide older people

with the care packages they need to leave hospital on time.

9. The reimbursement charge will be set at a fair daily rate. In the

original consultation document the figure o f £100 per day was

suggested, and £120 in the south east; responses to the consultation

suggested that this was a fair amount. The exact amount of charge

will be laid out in regulations, on which the Department of Health

has consulted. The regulations will be published shortly.

10. As well as the compromise offered on the date of implementation,

the government also agreed a number of other changes to the Bill,

relating to patient and carer consultation, inclusion of mental

health patients and the minimum period allowed for local authorities

to assess patient needs and provide services before charging starts.

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