Whether a hospital admission is planned or unexpected, the hospital discharge process can be a worrying time for patients and their families. Some patients find that they are pushed to accept a care home option because they are not offered the right support to return to live at home. Other patients find that the discharge planning process recommends a return home, when they would feel safer with a temporary or long term care home placement.
It may be useful to refer to our list of Abbreviations Used in Community Care Law.
From March 2020 to March 2022, central Government funding was made available to assist Health and Social Services in releasing hospital beds to new patients. Often referred to as “Discharge to Assess” (D2A), the series of policy and operating models were mandatory, and many of the assessment and care planning duties that had previously applied to safe discharge from hospital were suspended.
Under the previous D2A policies, people being discharged from hospital who had care and support needs should have received a fully funded package of care either at home, or in a care home setting, for up to six weeks if discharged before July 2021, or up to four weeks if discharged between July 2021 and April 2022. During that fully funded period, Health and Social Services were required to undertake assessments to inform the person’s longer term support needs and appropriate care arrangements.
The Government’s central D2A funding ceased on 31 March 2022: Health and Social Services were advised to create their own local D2A policies and decide whether to make full funding available to support timely discharge from hospital.
The Government has made £500m available to Health and Social Services across England through the Better Care Fund to support D2A schemes at local level across England for Autumn / Winter 2022 – 2023. This additional social care funding is designed to reduce the immense continuing pressure on hospital beds, with 13,000 of 100,000 hospital beds occupied by people who need a package of care in the community.
This newest version of D2A funding is not supported by any central Government policy or operational model, the aim being that local social care departments will have discretion about how to use the funding. This may mean that some people will miss out on social care discharge funding at a critical time in their lives.
Many patients being discharged from hospital are not made aware that they may qualify for short-term funding support during the time that it takes for their Health and Social Care assessments to be completed. This may mean that they are being treated as self-funders for their care costs without a proper or lawful needs assessment.
Patients who are made aware of D2A funding and support may find that they have little if any choice about their first discharge destination. This can have a long term impact on the person because it is important to get discharge destination “right first time” where possible, to avoid multiple moves. They may feel pushed to accept a temporary move to a care home, because social care staff shortages make it difficult to have a safe or sufficient package of care at home.
As the hospital discharge process now progresses very quickly, we recommend seeking urgent legal advice as soon as you have concerns about unsafe or inappropriate discharge arrangements. Despite the D2A priority of releasing hospital beds as swiftly as possible, there are still many ways in which an unsafe hospital discharge or inadequate care plan can be challenged. Furthermore, there should be additional funding available for care and support during this period so that no discharge is unsafe.
If the patient lacks mental capacity to make decisions about their care arrangements, the hospital staff should follow the best interest decision making principles set out in the Mental Capacity Act 2005. If a mental capacity and best interest assessment is required, this should still take place in hospital.
There are occasions when people are effectively forced into accepting unsuitable care arrangements. In ordinary times, the pressure results from Health or Social Services cost restraints. During periods of economic crisis post-pandemic, the situation will be exacerbated by heightened time pressures within hospital settings. At a time of great vulnerability, patients can feel deprived of their dignity and independence.
If hospital discharge is delayed when somebody is asking to leave or has become medically fit, this may amount to a deprivation of liberty and/or an unlawful detention. There may also be safeguarding implications associated with a prolonged discharge or an overly quick discharge to an unsafe destination, or with inadequate care and support.
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