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
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
'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.'
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
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.