6.
This is a national development which local authorities and health
economies have to implement fully by January 2004. The Directorate of Social Services and Housing has always worked
closely with health partners to prevent delays and the development of
Intermediate Care Services has featured in both Service Plans and Local Delivery Plans. The partnership work which underpins the
implementation of the new legislation is also recognised in the Statement of
Intent and the endorsed action plan.
CONSULTATION
7.
The
Joint Protocol which supports the local implementation of the legislation is
currently being consulted on. The new
legislation was consulted on nationally.
FINANCIAL/BUDGET IMPLICATIONS
8.
The
existing pooled budget for Free Nursing Care amounts to roughly £5.7m over a
three year period. The new pooled budget would be set up using existing
allocated resources between health and social care. Liabilities for each organisation will be set out in a ‘Section
31’ partnership agreement that will need to be signed by each organisation. The
details of the current budgetary allocation to the Social Services &
Housing Directorate for reimbursement is approximated below.
|
Current Commitment
|
2004/5
|
2005/6
|
2006/7
|
|
|
|
|
|
Delayed Discharges
|
308K
|
225K
|
150K
|
|
Intermediate Care
|
300K
|
309K
|
318K
|
|
|
608K
|
534K
|
468K
|
These figures are provided as indicative amounts
but are dependent upon grants and changes to legislation and government
targets.
LEGAL IMPLICATIONS
9.
The
partnership agreement will be set up within Section 31 of the Health Act 1999
and the Partnership Regulations.
OPTIONS
10.
The
Council has two options:
·
To
establish a pooled budget with the Primary Care Trust.
·
To
keep separate budgets for Reimbursement and Intermediate Care.
EVALUATION/RISK MANAGEMENT
11.
The aim of setting up a pooled budget with the Primary Care Trust is to
ensure that the new funds allocated to the Local Authority can be used to
invest in services to prevent delays rather than pay reimbursement. By having a pooled budget, the Primary Care
Trust will claim funding back from the Isle of Wight Healthcare NHS Trust if
reimbursement should apply and put the funds back into the pool. The
Primary Care Trust will be able to do this because it already pays for an
average number of delays in the services it commissions. By working together both organisations can maximise the benefits for
service delivery. If there is no pool
of resources, additional delayed discharge funding is more likely to be used
for the payment of reimbursement rather than used pro-actively to invest in
services. The management of risks will
be via the partnership agreement.
|
RECOMMENDATIONS
12.
That the Executive
agree a pooled budget for Reimbursement of Delayed Discharges and
Intermediate Care between the Primary Care Trust and the Social Services and
Housing Directorate is constructed using a Section 31 Agreement for a period
of 3 years to take effect from April 2004.
13.
That the Executive endorse the approach taken with the Free Nursing
Care pooled arrangement s and support the extension of this for a further 3
years from April 2004, subject to a final evaluation.
|
BACKGROUND PAPERS
14.
HSC
2003/009:LAC (2003)21: The Community Care (Delayed Discharges etc) Act 2003
Discharge from Hospital, pathway process & practice
Health & Social Care
Joint Unit & Change Agent Team 2003
Department of Health web site:
http//www.doh.gov.uk/reimbursement/ddgrant.htm
ADDITIONAL INFORMATION
15.
Implementing
Reimbursement for Delayed Discharges paper (Appendix 1)
Contact Point : Gillian Baker, Deputy Director Of Commissioning & Partnerships
Isle Of Wight Primary Care Trust
& Social Services
Tel: 01983 535 419
Email: [email protected]
|
S WELLER
Head Of Adult Services
|
G KENDALL
Portfolio Holder for
Social Services and Housing
|
Appendix 1
Isle of Wight Primary Care Trust
Isle of Wight Directorate of Social Services
IMPLEMENTING REIMBURSEMENT FOR DELAYED DISCHARGES
NOVEMBER 2003
1. Background
1.1
Proposals for
Reimbursement for delayed discharges were made by the government following
evidence presented at the National Beds Enquiry. This showed that delays in discharge were usually the result of
poor bed management, with lack of attention to discharge planning, and a
failure of communication between health and social care systems.
1.2
The aim
behind the Community Care (Delayed Discharges etc) Bill in April 2003 was to
introduce a financial incentive to ensure patients receive the right level of
care, in the right place, at the right time.
The government has concentrated on delays in transfer from acute care,
however the aim is to extend to other parts of the system.
2. The
Objective of the New Legislation
·
To end
widespread delays by 2004.
·
To encourage
partnership working within the scope of the Health Act 1999.
·
To provide
effective, timely, safe and appropriate transfer of patients our of acute
hospital beds and promote the independence of older people in particular by
creating incentives to discharge from the institutionalising effects of acute
inpatient care.
·
To encourage
a proactive approach to the prevention of delays.
·
To encourage
cross agency and inter-disciplinary working in support of effective discharge
in a whole systems approach.
3. Requirements
of the Act
3.1 The Delayed Discharges Act places new
duties on both local authorities and NHS trusts in relation to discharge
planning and community care arrangements.
These commenced on the 1st October 2003.
3.2
There is a specific duty on NHS trusts, to
notify the relevant local authorities as soon as it becomes apparent that a
patient receiving acute care may require community services upon discharge. There are exemptions, these include patients
receiving mental health care, learning disabilities services, rehabilitation,
maternity services and GP led care.
3.3
From 1st October 2003, NHS trusts
should be notifying the Social Services in accordance with jointly agreed
operating procedures. The necessary
infrastructure should be in place in readiness for full implementation from
January 2004.
3.4
Social Services departments have 3 working
days to implement appropriate discharge following notification that the patient
is medically fit and when the multidisciplinary team have determined the
patient is safe for discharge.
3.5
Acute Trusts also need to notify Social
Services of any changes in the patient’s readiness for discharge, such as
deterioration in the patient’s condition.
3.6
Agreements between the PCT, Social Services
and the IWHCT need to be in place before actual reimbursement takes place in
January 2004.
4. Funding
Arrangements & Expenditure
4.1 £100 million of new funding is to be
transferred from central NHS funds to local authorities in each full year of
the scheme, to enable local authorities to tackle these delayed
discharges. This follows the
distribution of £300 million building care capacity grant to local authorities
in October 2001.
4.2
To further support this work, the Department of Health is launching the Access
and Systems Capacity grant, this will provide a further £170 million to local
authorities 2003/2004. The national
scale of charges has been agreed at £100 per day of delay.
4.3
Locally, £152,000 has been allocated to the
Isle of Wight Social Services & Housing Directorate for the remainder of
this financial year to support the introduction of the bill. (This will be increased for the full year
effect in 2004/05).
4.4
It should be noted, that there is no rigid
guidance on the use of this funding.
However, there is an expectation that funding may be invested proactively
to support arrangements that operationalise, the management/prevention of
delayed discharges and also provide a reserve to cover the costs of
reimbursement should these be incurred.
4.5
The Steering group has directed how the
current budget should be spent and decisions have been taken to strengthen the
infrastructure and support services to minimise probability of delays.
·
The Hospital
Care Management Team will receive additional resources to ensure there are
sufficient Care Managers to be allocated to wards in order to appropriately
assess patients and put care packages together.
·
There will be
a part time Finance Officer who will track all the notification process on
behalf of both Health and Social Care.
·
Investment
has gone into additional Nursing Home beds.
5. Local
Implementation of the New Arrangements
5.1 A
cross agency Steering Group has been established, and two subgroups were
formed. One to deal with Finance and
the other to develop policy and procedure.
5.2 A
draft protocol has been produced and will be put into practice during November
2003 to test its effectiveness. This
protocol, which sets out organisational arrangements, roles and responsibilities,
is for consultation. Comments should be given to Conal Grier c/o PCT at
Whitecroft by the end of November 2003, ready for a final document to be
produced in December 2003.
In
summary the protocol addresses the key requirements as set out below:
·
Accurate
screening for discharge of all hospital admissions – both elective and
emergency
·
Identification
of high risk patients where there is a probability of delay to promote
proactive discharge management
·
Systems
through which to agree delays
·
Systems
through which to manage reimbursement
5.3 The Steering group has had to consider and
resolve a number of issues:
·
The IWHCT has
counted rehabilitation beds within its stock of acute beds for the SITREP
return. Under the new legislation
reimbursement only applies to delays from acute beds and rehabilitation beds
are an exclusion from this. SITREP
returns will now only reflect delays from acute beds for reimbursement. However data will continue to be collected
on delays from all areas, and equal importance will be given to resolving
delays from wherever they occur.
·
It is also
recognised that following the local bed census, a reconfiguration and
redesignation of beds within St Mary’s will take place in early 2004. This will need to be reflected in the protocols
and SITREP returns.
·
The
philosophy behind the Delayed Discharges Bill is to encourage partnership
working to prevent delays. The focus of
the new money is to use it for investment to prevent delays. It is clear double funding of the acute
sector should not occur and therefore PCT’s should amend Service Level
Agreements. This is currently being
considered. The PCT will use any
funding reclaimed to be reinvested in services to prevent delays for 2003/04.
6. Risk
Analysis
6.1 Homecare - When the Steering Group started
reviewing the implementation of the guidance in early summer, the main area of
risk for delays was lack of nursing home capacity. 10 new beds in the nursing home sector, which have been developed
through support of the Intermediate Care Capital Scheme, are currently
available and have been block purchased between the PCT and Social
Services. However, recent exacerbation
of the problems within the Homecare Market and shortage of carers is now a new
real risk in supporting discharge.
Social Services have an action plan to address this and further
investment to support this sector is required.
6.2 The Bed Census report has recently
highlighted a significant number of patients who do not need to be in hospital
and could be cared for in the community.
These are not people who are counting as delays in the SITREP returns as
discharges dates have not been agreed.
6.3 Through the introduction of more effective
discharge planning significantly more patients will be identified for earlier
discharge, the full impact of this for Social Services has not been
modelled. Changes in current practice
within the hospital will impact on Primary and Social Care, and new community
beds and homecare support will be required.
The lead-time for developing additional support in the community should
not be underestimated and bed closures at St Mary’s will need to be managed in
tandem with development of community services.
7. Proposed Way Forward
7.1 Pooled Budgets - The whole health and social
economy has a vested interest in ensuring that the new funding available for
reimbursement of delayed discharges is used effectively to prevent delays.
7.2 It is therefore proposed that a pooled
budget is set up from April 2004. This
recommendation is in the action plan and timetable, which has been agreed by
ISG as part of the statement of Intent.
The pooled budget would be a combined PCT and Social Services budget for
both Intermediate Care and Delayed Discharges and would be used to commission
Intermediate Care services and other services required to avoid delays.
7.3 The
initial proposals for a pooled budget are that it should contain:
-
Funding for
NHS Nursing Home beds
-
Funding for
Independent Living Resource Centre beds
-
Funding for
Intermediate Care Team
-
Funding for
the Homecare Rapid Response Team
-
Funding
allocated for Reimbursement of Delayed Discharges
-
Funding
reclaimed by the PCT as a result of reimbursement to avoid double counting in
the acute
The Joint Commissioning Team would manage
the budget.
7.4 As
with other pooled budgets, a partnership agreement would be drawn up between
the PCT and Social Services and agreement will be reached on a tripartite basis
to include the IWHCT on how the additional reimbursement funding for 2004/5 can
be used most effectively to avoid delays.
7.5
Protocol - Following consultation on the Draft Joint Protocol, a new
protocol will be drawn up and however it is envisaged that this will be a
iterative process and continue to be developed.
7.6 Delayed Discharge Policy - The Delayed Discharge Policy
is currently being amended to reflect the requirements of reimbursement.
7.7
Training and Awareness - Training Sessions for nursing staff will be
available in November and a number of Awareness Sessions will be put on for
both Health and Social Care Staff. A
wider stakeholder session will also be set up and discussions have already been
held with interested groups such as Age Concern.
7.8 Media
relations will be considered by the Steering Group and proposed press releases
will be developed.
CONCLUSION & RECOMMENDATION
8.1 The Local Authority and Primary Care
Trust are asked to approve the proposal to set up a pooled budget for
commissioning Intermediate Care Services including Delayed Discharge funding.
8.2 Both organisations and the IWHCT are asked to consult on the
draft protocol for agreement to be reached in December 2003, ready for full
implementation January 2004.
Gillian Baker
October 2003
