Select committee inquiry
Discharging Older People from Acute Hospitals inquiry
Closed
What the inquiry looked at
“Many older people, each year, find themselves unable to leave hospital, even though their treatment has been completed. This significantly reduces their quality of life and undermines the ability of hospitals to treat more patients and meet testing targets. There are also pressures resulting from emergency readmissions. Emergency readmissions within 28 days of leaving hospital run at around 15 per cent for people over 65 (2015, King's Fund). In improving support for older people in their homes—either to prevent hospital admission (or readmission) or making discharge easier when the patient is ready to leave hospital, is crucial to manage patient flows in acute hospitals and ultimately to delivering good patient care. The National Audit Office (NAO) are currently conducting a study to examine whether the health and social care sectors are effectively managing the discharge of older patients from acute hospitals, focusing in particular on whether acute hospitals are minimising the delays throughout the older patient pathway, enabling them to discharge patients as soon as possible. The study will also look at whether local systems are working together to facilitate the efficient and effective discharge of older patients, including considerations of capacity and skills. The NAO work is also considering whether national assurance, performance management and support arrangements around patient flow and discharging of older patients are providing value for money.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of 12th Report - Discharging older people from acute hospitals ↗
Increasingly, older patients are experiencing delays in being discharged from hospital.
Such delays are bad for their health and increase the level of care they may need after leaving hospital. Unnecessary delays are also bad for the financial sustainability of the NHS and local government and the National Audit Office (NAO) has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there. While it is clear there have been improvements and many in the NHS and local government are putting in significant efforts, the Department of Health (the Department) and NHS England rely too easily on differing local circumstances as a catch-all excuse for not securing improvement in performance. They should be doing more to increase the pace of integration and make local accountability systems more effective. Those areas which are doing best are the ones where all the local system owns all of the problem but this practice is all too rare.
The Department, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice. The result is unacceptable variation in local performance. While we recognise there are significant pressures on adult social care and NHS funding, NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement. Patients and the NHS have a right to expect better.
What the government said
No government response is linked to this report.
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 28 April 2016 to its close on 4 January 2018.
- Oral evidence 6 Jun 2016
- Report 22 Jul 2016
What it recommended 1 recommendation · 29 conclusions
1There is a poor understanding of both the scale and cost of the problem of...
Concluded (the committee's words)
There is a poor understanding of both the scale and cost of the problem of delays in discharging older patients from hospital. The official data substantially under-estimate the range of delays and the number of older patients who are delayed. The NAO estimates that the number of hospital bed days occupied by older people who are no longer benefiting from acute care is approximately 2.7 million a year (higher than the official delayed transfer of care figure for all adult patients of 1.15 million), at an estimated gross cost of around £820 million. These estimates are in line with the recent Carter Review. The NAO also estimates that the public cost of providing out of hospital care for these patients may be around £180 million. NHS England estimated that the net costs could range from £0 to £640 million with a mid-range estimate of between £300 million and £400 million. If the NHS is serious about moving older patients of hospital as soon as they are ready, it needs to understand the true scale of the problem, and what resources are involved in caring for these patients in hospital or in alternative, more appropriate settings. Recommendation: NHS England should develop measures that fully capture the number of older people who are no longer benefiting from acute hospital care. Also, building on the initial work set out in the NAO report, NHS England should coordinate work to fully understand the cost to hospitals of delayed discharges and the costs, where these fall on the public purse, of caring for these people in the community.
2There is unacceptable variation in local performance on discharging older patients.
Concluded (the committee's words)
There is unacceptable variation in local performance on discharging older patients. As an indication of the variation across different areas, for the hospitals within the Committee member’s constituencies, the number of officially recorded delayed transfers of care in 2015–16 ranged from 10 days in Northumbria to nearly 18,000 days in Lincolnshire. The Department agrees that there is unacceptable variation in the performance of local areas on discharge delays. It told us that there are 65 local authority areas (out of 152) whose current levels of delay have improved from their levels of two years ago. Out of the remaining 87, there are also 22 areas with rates of delay that are at least three times worse than the group of 65 authorities which have improved. The NAO report also shows significant variation between hospitals in the proportion of older people attending A&E who are then admitted to hospital from 37% to 61%. Recommendation: There are several contributory factors behind the variations in local performance. We expect the Department, NHS England and NHS Improvement to understand the reasons for the variations and address the further recommendations we make below.
3The fragility of the adult social care provider market is clearly exacerbating the difficulties in...
Concluded (the committee's words)
The fragility of the adult social care provider market is clearly exacerbating the difficulties in discharging older patients from hospital. NHS England believes the increasing pressure on adult social services will prevent significant progress being made in reducing the number of delayed discharges over the next five years. Local authority spending on adult social services has fallen by 10% in real terms between 2009–10 and 2014–15. This is putting pressure on local authorities to reduce fees which in turn puts pressure on care providers. The introduction of the national living wage is adding further to this pressure. Most home care and residential/nursing home 6 Discharging older people from acute hospitals care is provided by private sector organisations who face significant issues with the recruitment and retention of home care workers and nurses in nursing homes, depending on other factors such as local employment markets and whether there is full employment. In some areas care providers are charging higher prices to people funding their own care compared to local authorities who benefit from bulk discounts. Recommendation: Our report on personal budgets in adult social care recommended that the Department clarify its position as national steward of the social care market in its National Market Position Statement. Given the effect that serious funding pressures and market fragility are having on discharging patients, we re-iterate this recommendation. The Department should report back to us by January 2017 on progress in implementing the key elements of the Position Statement and what impact this is having.
4While good practice on discharging patients from hospital is well understood, implementation is patchy across...
Concluded (the committee's words)
While good practice on discharging patients from hospital is well understood, implementation is patchy across local areas. Good practice in discharging older patients is well understood with some elements that all local areas should have. These include: avoiding older people being admitted to hospital unnecessarily; starting assessments and discharge planning early; maintaining the momentum of treatment while in hospital; joint/shared patient assessments between health and social care providers; and undertaking the assessment of patients long-term care needs in the most appropriate setting, whenever possible in their own home. While some local areas have made progress, overall take-up of good practice is slow. NHS Improvement’s remit is to disseminate good practice across the NHS. Its model is to encourage organisations to go and look at other organisations that are doing it well and there are examples of where this is happening. However, this bottom-up approach does need to be balanced against the need to increase the pace of implementation. Recommendation: NHS England and NHS Improvement should report back to us by January 2017 on what steps they have taken to increase the pace of good practice adoption.
5The absence of widespread and effective sharing of patient information remains a significant barrier to...
Concluded (the committee's words)
The absence of widespread and effective sharing of patient information remains a significant barrier to the effective discharge of older patients. The extent to which patient information is shared varies across local areas and difficulties in sharing patient information remain a significant issue. Patients and families often have to repeat information on their care history and current circumstances across different health and social care organisations. Northumbria Healthcare NHS Foundation Trust, which has an excellent record on reducing delayed discharges, regards the ability of its hospital staff to access GP patient records as a vital part of being able to plan patient’s care and discharge. It also uses community matrons to facilitate the sharing of information, but the use of community matrons varies across other local areas. Discharging older people from acute hospitals 7 Recommendation: NHS England, working with local government partners, should identify early lessons from the ongoing work on information sharing, so that health and social care providers can get a clear idea of what will work best in their local area. It should report back to us by January 2017 on what progress has been made on information sharing in local areas.
6Current structures do not have an effective line of accountability, either nationally or locally, for...
Recommended (the committee's words)
Current structures do not have an effective line of accountability, either nationally or locally, for what is at root a shared problem for health and social care systems of discharging older patients. There is a fragmented accountability structure which makes it more difficult to implement and drive forward change. At a local area level, there is no single point of accountability for health and social care services. NHS England stated that system resilience group chairs are accountable to NHS England, but directors of adult social services that sit on these groups are not. At a national level, NHS England and NHS Improvement are responsible for improving services and the implementation of good practice across NHS organisations. However, they have no responsibility for, or control over, local authorities whose elected officials are accountable to their local electorate. Recommendation: As steward of the system, the Department of Health should set out in its accountability system statement how local health and social care systems will be held to account for areas of care that require a whole system approach, such as discharging older patients. This could, for example, involve strengthening the remit of the national Discharge Programme Board and local system resilience groups to hold the whole system to account.
7Local health and social care organisations are too often not working together effectively, with organisational...
Concluded (the committee's words)
Local health and social care organisations are too often not working together effectively, with organisational boundaries getting in the way of what should be a smooth and seamless process for the patient. Patients and families often find it difficult to navigate the ‘crazy paving’ of local health and social care organisations and can find themselves caught up in delays, or passed back and forth, between different bodies. Some of the local areas that are performing best on discharging patients are those that are fully integrated, such as Northumbria where the NHS Foundation Trust controls acute and community health services and also adult social services. While a single top-down approach may not always be appropriate, different local circumstances should not be an excuse for lack of progress on effective joint working. Irrespective of local circumstances, strong leadership to bring local organisations together is important. System resilience groups have a remit to oversee the coordination and integration of services. However, these groups are not yet consistently effective. In 2016–17, NHS England and NHS Improvement will be leading a review and refocusing of system resilience groups. Recommendation: NHS England, working with local government partners, should clearly set out good practice models for integrated and closer working that they expect to be adopted by local health and social care systems, and report back to us by January 2017 on what steps they have taken to increase the pace of adoption of such models. 8 Discharging older people from acute hospitals
8Financial incentives across local health and social care systems are not encouraging all organisations to...
Concluded (the committee's words)
Financial incentives across local health and social care systems are not encouraging all organisations to work together to reduce delays. Reducing the length of older patients’ hospital stays will reduce their longer-term care needs and ultimately care costs. However, short-term financial incentives to discharge older patients as soon as possible from hospital are not aligned across local health and social care organisations. The Better Care Fund promotes closer joint working through a pooled budget for health and social care services, but most areas have not met their planned reductions in delayed discharges. Due to this lack of progress, the Department is requiring areas to put in place risk-sharing mechanisms to try and ensure incentives are aligned across the different health and social care organisations. Acute hospitals are able to fine local authorities if the authority is responsible for a delayed discharge. However, fines are not imposed by most hospitals—only 23% of authorities were fined in 2014–15 and the amount involved was minimal (around £2 million). Neither NHS Improvement or the Local Government Association saw fines as an effective way to improve incentives. Recommendation: NHS England and NHS Improvement, working with local government partners, should seek to understand which contracting and payment mechanisms, including targeted use of fines, offer the best incentives for community health providers and local authorities to integrate and co-ordinate their activities better and accept patients as quickly as possible. Discharging older people from acute hospitals 9 1 Performance
9Local authority spending on adult social care has fallen by 10% in real terms between...
Concluded (the committee's words)
Local authority spending on adult social care has fallen by 10% in real terms between 2009–10 (£16.3 billion) and 2014–15 (£14.6 billion). The Association of Directors of Adult Social Services and the Local Government Association said that the funding cuts were increasing the pressure on local authorities and providers. As set out in the NAO report, commissioners of adult social care are under pressure to keep the fees they pay to providers as low as possible, which is in turn putting pressure on providers. The report also highlighted a 2015 survey by the Association of Directors of Adult Social Services where 56% of directors thought service providers were facing financial difficulty. The Association of Directors of Adult Social Services also cited the introduction of the national living wage as a factor increasing the pressure further on funding and providers.12 NHS England said that the pressure on local authority funding would see a widening gap between the availability of, and the demand for, adult social care over the next few years. It stated that this would impact on the NHS, showing up as delayed discharges, and would prevent significant progress being made in reducing delays over the next five years.13 11 Qq 63, 64, 152 12 Qq 2–3, 83, 108; C&AG’s Report, paras 3.3–3.5 13 Qq 68, 74, 110, 116 Discharging older people from acute hospitals 13
10The Association of Directors of Adult Social Services noted that there was no correlation between...
Concluded (the committee's words)
The Association of Directors of Adult Social Services noted that there was no correlation between the size of local authority funding cuts and performance on delayed discharges, citing Northumbria Healthcare NHS Foundation Trust where significant funding cuts had not impacted on its performance on delays.14 However, the Association of Directors of Adult Social Services and the Local Government Association said that funding cuts were having a significant impact on the adult social care market. Most providers of care were private sector organisations, which were having difficulties in the recruitment and retention of home care workers and nurses in nursing homes. The Department said that factors such as local employment markets and whether the local area has full employment also impact on the local markets. The NAO report highlighted the variation in vacancy rates across the country for residential and home care workers and also high staff turnover rates in these areas.15
11The Local Government Association recognised that local authorities and individuals funding their own care were...
Concluded (the committee's words)
The Local Government Association recognised that local authorities and individuals funding their own care were paying different prices for care, with local authorities benefiting from bulk purchase discounts. Where fees for individuals were significantly higher, the Local Government Association said that individuals should be asking providers what they were getting for the money. It also said that, where fees were very high for individuals funding their own care, this made it more difficult for local authorities to negotiate adequate supply from care providers. The Department confirmed that it had recently written to every local authority reminding them of their duties under the Care Act to promote a sustainable market including diversity and choice.16 14 Qq 2, 8 15 Qq 2, 3, 10–12, 83, 108, 151; C&AG’s Report, figure 13 16 Qq 160–161 14 Discharging older people from acute hospitals 2 Good practice Adoption of good practice
12Both the Department and NHS England agreed that there was a good understanding of good...
Concluded (the committee's words)
Both the Department and NHS England agreed that there was a good understanding of good practice in discharging older patients from hospital.17 This includes: avoiding older people being admitted to hospital unnecessarily (for example, through setting up frailty units);18 starting assessments and discharge planning early; maintaining the momentum of treatment while in hospital, for example increasing the level of discharges before midday and at the weekend; joint/shared patient assessments between health and social care providers (‘trusted assessors’);19 and undertaking the assessment of patients long-term care needs in the most appropriate setting, whenever possible in their own home (‘discharge to assess’).20 NHS England confirmed there have been a series of publications with organisations such as the Local Government Association and the Association of Directors of Adult Social Services setting out good practice in this area.21
13Both the Department and the Association of Directors of Adult Social Series stated that there...
Concluded (the committee's words)
Both the Department and the Association of Directors of Adult Social Series stated that there were examples where good practice was being implemented. NHS England cited the examples of Northumbria and other vanguard areas that have been set up as part of its Five Year Forward View programme. These areas were demonstrating what can be done in implementing good practice and the impact this can have.22 The Local Government Association stated that changing the culture across organisations was vital. It cited the example of Leicester where the cultural change has been across all of the organisations with every person asking the question “Why not home, and why not today?”. The Association stated that it was important to get every person focusing on what is right for each individual patient.23
14NHS England confirmed that not all hospitals were implementing good practice.
Concluded (the committee's words)
NHS England confirmed that not all hospitals were implementing good practice. NHS Improvement said that, in a number of areas of good practice highlighted in the NAO report, it would expect to see widespread implementation such as trusted/joint assessment and ‘discharge to assess’ schemes.24 The NAO report shows that only 49% of hospitals had ‘trusted’/joint assessment arrangements in place with their local authority and 52% had discharge to assess schemes in place where the assessment of a patient’s future care needs is done outside hospital. The Department also stated that there are some essential elements of good practice that every place should have and that over the next year there should be a systematic approach to making sure they are in place.25 17 Qq 53–54, 104, 151 18 Frailty units are dedicated teams of specialist doctors, nurses, therapists or social workers operating in A&E and short stay units to carry out early assessment of older patients’ needs. 19 Under trusted assessor arrangements, health and social care professionals complete a single assessment of patients’ needs, which can be shared, reducing duplication. 20 Under ‘discharge to assess’ schemes, planning, assessment and arranging ongoing care takes place in the patient’s home rather than hospital, as soon as their acute treatment is complete. 21 Qq 2, 4, 54 22 Qq 2, 18, 64, 68 23 Q 109 24 Qq 110, 130–133, 148–150 25 Q 151; C&AG’s Report, figure 10 Discharging older people from acute hospitals 15
15NHS England and NHS Improvement confirmed that NHS Improvement was responsible for ensuring the spread...
Concluded (the committee's words)
NHS England and NHS Improvement confirmed that NHS Improvement was responsible for ensuring the spread of good practice across the NHS. NHS Improvement set out its model for the dissemination of good practice which is to encourage organisations to go and look at other organisations that are doing it well. It cited the example of the quality improvement programme it has set up at Leeds Teaching Hospitals which had resulted in a 30% reduction in delayed discharges. This is being rolled out as a pilot across the North of England with plans to take the good practice and use it across the NHS.26 Northumbria Healthcare NHS Foundation Trust said that over 50 trusts had visited to look at its systems. The Department stated that there are advantages to a bottom-up approach as you get local ownership. However, it also said that this approach needed to be balanced against the need for more pace in implementing good practice and the degree to which the centre prescribes what local areas should do.27 Sharing patient information
16The NAO report showed that the sharing of patient information is a barrier to the...
Concluded (the committee's words)
The NAO report showed that the sharing of patient information is a barrier to the smooth transition of patients into and out of hospital. This includes both the information provided to hospitals when people are admitted and also the information provided to ongoing care services (community health and adult social care) following discharge from hospital. Independent Age said that hospitals often relied on family members to provide information on a patient’s circumstances outside hospital. It said that families often have to repeat background information, such as current medication, across different people and organisations they encounter. Independent Age had concerns about how information was provided for those patients who did not have people to represent them.28
17Northumbria Healthcare NHS Foundation Trust said that in an acute hospital setting they are often...
Concluded (the committee's words)
Northumbria Healthcare NHS Foundation Trust said that in an acute hospital setting they are often dealing with patients they have never seen before. The Trust recognised the importance of its hospital staff being able to access patient information and, in particular, its ability to interrogate GP patient records. It described the IT system it had recently put in place which allows hospital staff, community nurses and social workers to access appropriate parts of the GP record. This information helped them to: avoid stopping care packages; ensure that adequate support is in place when patients leave hospital; and highlight to community nurses areas that may require further monitoring and assessment.29
18Northumbria Healthcare NHS Foundation Trust also highlighted the important role played by community matrons in...
Concluded (the committee's words)
Northumbria Healthcare NHS Foundation Trust also highlighted the important role played by community matrons in sharing patient information and ensuring continuity of care for patients. The Association of Directors of Adult Social Services said that there was local variation in the extent to which community matrons are used and patient information is shared.30 The NAO report showed that the numbers of nurses working in community services had fallen by 13% between 2009 and 2015.31 26 Qq 68, 71, 75, 101–102 27 Qq 9, 147 28 Q 32, C&AG’s Report, para 3.20 29 Qq 20–23 30 Qq 30–31 31 C&AG’s Report, para 3.7 16 Discharging older people from acute hospitals 3 Accountability and integration Accountability
19NHS England acknowledged that there was fragmentation in the care system following the Health and...
Concluded (the committee's words)
NHS England acknowledged that there was fragmentation in the care system following the Health and Social Care Act 2012. It said there are a range of organisations with different statutory accountabilities, with some organisations within the NHS and others such as local authorities outside. It went on to say that this accountability structure was making it more difficult to drive forward change and it was doing its best to work around this structure.32
20At a local area level, NHS England said there was no single person or organisation...
Concluded (the committee's words)
At a local area level, NHS England said there was no single person or organisation with overall responsibility for delayed discharges across the local health and social care systems. It cited the example of ‘system resilience groups’ where it said the group chairs are accountable to NHS England, but the directors of adult social services, that sit on these groups, are not.33
21NHS England set out that, at a national level, NHS England and NHS Improvement are...
Concluded (the committee's words)
NHS England set out that, at a national level, NHS England and NHS Improvement are responsible for improving services and the implementation of good practice across NHS organisations. However, they have not got responsibility for, or control over, local authorities, who are accountable to their local electorate.34
22The Association of Directors of Adult Social Services and the Local Government Association emphasised that,...
Concluded (the committee's words)
The Association of Directors of Adult Social Services and the Local Government Association emphasised that, irrespective of the local organisational structures in place, strong leadership was a vital part of improving the way local health and social care organisations work together.35 NHS England has established system resilience groups as the key local forum for planning capacity and overseeing the coordination and integration of local services. The Local Government Association cited the example of Oxfordshire where strong leadership within the system resilience group had resulted in a significant improvement in relationships across local organisations and this was starting to improve the performance on delayed discharges. However, both the Association of Directors of Adult Social Services and NHS England said that there was variability in the effectiveness of system resilience groups across the country. NHS Improvement stated that, during 2016–17, it would be jointly leading with NHS England a review and refocusing of system resilience groups with the aim of improving their effectiveness.36 Integration of local health and social care organisations
23Witnesses highlighted the challenges that organisational boundaries pose for patients.
Concluded (the committee's words)
Witnesses highlighted the challenges that organisational boundaries pose for patients. Independent Age talked about the ‘crazy paving’ of health and social care services across the country which makes it more difficult to advise patients and families about issues such as who is responsible for services and who to contact about the choices available. In its casework, Independent Age has seen examples of: delays due to conflicts about funding between the NHS and local authorities; poor co-ordination in assessing care needs 32 Qq 75, 77, 139 33 Qq 72–78, 34 Qq 75, 139, 145–146; C&AG’s Report, para 3.26, figure 19 35 Qq 24, 57 36 Qq 38, 53, 57–58, 71; C&AG’s report. Para 3.11 Discharging older people from acute hospitals 17 which result in older patients receiving the wrong care and ultimately being readmitted to hospital; and a lack of co-ordination in the provision of equipment and re-ablement services (care aimed at maximising people’s independence).37
24The Department stated that some of the systems that are doing the best in reducing...
Concluded (the committee's words)
The Department stated that some of the systems that are doing the best in reducing delayed discharges were those that are fully integrated—where local providers have come together so that ‘all the system owns all of the problem’.38 One example of this is Northumbria Healthcare NHS Foundation Trust which has very few delayed discharges (see Figure 1). The Trust manages both the acute and community hospitals in Northumbria. In addition, since September 2013, it has managed the adult social services for Northumberland County Council. The Trust set out its experience of working across traditional organisational boundaries and the benefits of doing so. It cited the example of its seven-day working across physiotherapists, occupational therapists, speech and language therapists and social workers within its multidisciplinary teams. The whole multidisciplinary team are coordinated, monitored and actively managed.39
25There are other areas that have introduced a similar structure to that of Northumbria, such...
Concluded (the committee's words)
There are other areas that have introduced a similar structure to that of Northumbria, such as Salford and Torbay, and the Department stated it had a growing interest in this approach. It said that the number of areas where an NHS trust was running adult social services was currently in single figures and this was likely to grow to about 20 based on those areas that were currently making preparations for such an approach.40 However, the Department, NHS England and the Local Government Association explained that this model may not be replicable across all areas and therefore it was not appropriate to impose a single top-down approach. NHS England added that it was not in favour of new legislation or a statutory reorganisation of health and social care. The Department explained that some health organisations were not ready to take on the control of adult social services. NHS England and the Local Government Association stated that the proportion of individuals funding their own care, as opposed to local authority funding, would also influence the appropriateness of the local organisational structure.41
26The Better Care Fund promotes closer joint working through a pooled budget for health and...
Concluded (the committee's words)
The Better Care Fund promotes closer joint working through a pooled budget for health and social care services with individual areas having plans to reduce delayed discharges. The Department said that, in the first six months, only 40% of local authority areas had achieved their planned reduction in delayed transfers of care.42 The Department said that one of the things the Better Care Fund has struggled with is a lack of alignment of incentives between the different local organisations. It stated that, due to the lack of progress to date on delayed discharges, it was taking a tougher approach in 2016–17 and requiring organisations to put in place risk-share mechanisms so that there is a joint and agreed responsibility for delayed discharges.43 37 Qq 1, 28 38 Qq 58, 106 39 Qq 4, 6–8 40 Qq 58, 84–88 41 Qq 55–61, 78 42 Q 117; C&AG’s Report, para 3.18–3.19 43 Qq 111, 117 18 Discharging older people from acute hospitals Incentive mechanisms
27NHS England stated that in some places there was a disconnect between hospitals and community...
Concluded (the committee's words)
NHS England stated that in some places there was a disconnect between hospitals and community health services in terms of incentives and the availability of community services. It also agreed with the NAO report that many local authorities do not have response time standards in their contracts with care home providers and this was an important part of making the system work more effectively. The Local Government Association said that there was no incentive for local authorities to leave people in hospital for longer than was needed as the longer older people stay in hospital the more their mobility and ability to perform everyday tasks will deteriorate; increasing their long-term care needs and therefore the costs.44
28As outlined in the NAO report, short-term financial incentives to discharge older patients as soon...
Concluded (the committee's words)
As outlined in the NAO report, short-term financial incentives to discharge older patients as soon as possible from hospital are not aligned across local health and social care systems. The report found that hospitals have financial incentives to minimise the length of stay for emergency attendances and keep space free for elective procedures for patients. However, community health providers and local authorities are not incentivised financially to speed up receiving patients discharged from hospital. Most of the community health providers the NAO spoke to were on a block contract without any activity-based payments.45
29The Department confirmed that there is a statutory mechanism for acute hospitals to fine, on...
Concluded (the committee's words)
The Department confirmed that there is a statutory mechanism for acute hospitals to fine, on a discretionary basis, local authorities if the authority is responsible for a delayed discharge. NHS England said that the level of fining was minimal. The NAO report showed that only 23% of local authorities were fined in 2014–15: for a total of around £2 million. The Local Government Association said there was a lot of evidence that, where a fining system was in place, local authorities had to put money aside to pay fines rather than invest to improve services such as home care.46
30NHS Improvement thought that there were better ways to improve incentives than the use of...
Concluded (the committee's words)
NHS Improvement thought that there were better ways to improve incentives than the use of fines. It cited the example of some vanguard sites, set up under NHS England’s Five Year Forward View, that were looking at establishing ‘whole-population’ budgets. NHS Improvement also said that, rather than using fines in a punitive way, local agreements should be made on using the money to invest in initiatives to help reduce delayed discharges.47 44 Qq 54, 118 45 C&AG’s Report, para 3.23 46 Qq 112–113, 118; C&AG’s Report, para 3.25 47 Qq 114–115 Discharging older people from acute hospitals 19
Evidence
Oral evidence sessions 1
- 6 Jun 2016No witnesses recordedparliament.uk ↗