£8.62m national hospital discharge scheme dosh for NHS West Yorkshire Integrated Care Board to buy short-term care placements

On 9th January 2023, Health and Social Care secretary Steve Barclay announced that the government was basically reintroducing the national hospital discharge scheme used to fund “short-term care placements” earlier in the covid pandemic, which was scrapped in April last year.

17% of patients in West Yorkshire NHS hospitals are judged to have “no criteria to reside” and West Yorkshire Integrated Care Board is being allocated £8.62m of the £200m national discharge scheme funding.

Calderdale Forum 50+ reports that,

• Local areas will buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds for those who need them
• Discharged patients will be given the support they need from GPs, nurses and other community-based clinicians to continue their recovery
• An additional £50 million capital funding will be used to upgrade and expand hospitals including new ambulance hubs and facilities for patients about to be discharged

NHS England guidance indicates that most of the “initial cohort of patients suitable for funding under this scheme” are those who are waiting in hospital for support packages for short term care and support in their home, or non-acute healthcare rehab/intermediate care.

This emergency funding to discharge hospital patients into short term social care will increase the workload for already-overstretched General Practice and community health services. NHS England Guidance issued on Friday 13th January mentions that the scheme requires “associated clinical support” as well as “bedded step down capacity” for discharged patients.

It directs that the national hospital discharge funding,

“should be used to purchase bedded step down capacity plus associated clinical support for patients with no criteria to reside but who cannot be discharged with the capacity available through existing funding routes or the ASCDF announced previously…

“It will also pay for any clinical advice or therapeutic interventions in a step down facility to support the patient’s recovery, reconditioning, or rehabilitation, to optimise their outcome in advance of discharge from the step down facility.”

If support packages for discharge were available, the patients wouldn’t need residential care.

As it is, NHS England has told integrated care boards that they should, where possible, use the funds to “block book” residential capacity, and that they,

“must work with local authorities to ensure that an appropriate, locally benchmarked, rate is paid for care…with rates set at a level that does not lead to local inflation in the cost of care.”

The January funding is to “fund maximum stays of up to four weeks per patient until the end of March”. This means it has to be spent quickly. But it took many weeks to distribute the first £200m of the Adult Social Care Discharge Fund, and the final £300m is only now being given to local organisations.

Update: Speaking at the Calderdale Adults Health and Social Care Board meeting on 19th January 2023, the Cabinet portfolio holder for Adult Services and Wellbeing, Cllr Josh Fenton-Glynn, asked where the space is in care homes for the extra beds. He said he was reviewing the capacity for this to make sure that discharge to assess is working.

Unlike the September 2022 £500m Adult Social Care Discharge Fund (ASCDF), all the £200m funding for the January national discharge scheme is being given direct to the NHS, rather than being split between the NHS and local authorities, and it is earmarked specifically for rapid, short-term discharge of inpatients.

For the September 2022 Adult Social Care Discharge Fund, West Yorkshire Integrated Care System (aka Health and Care Partnership) received £15.4m, allocated to the NHS West Yorkshire Integrated Care Board, and £8.4m as Grant Allocations to Local Authorities.

The Adult Social Care Discharge Fund money was pooled into the Better Care Funds held at Local Authority Level. The Better Care Fund holds shared NHS money and local authority social care money, with the pooled funding to be spent on adult social care services which also have a health benefit. It is a way of transferring NHS money into cash-strapped Councils’ social care budgets.

This Better Care Fund allows the Council and the place-based subcommittee of the NHS Integrated Care Board to jointly co-commission adult social care services that aim to cut emergency hospital admissions and speed up hospital discharge of patients who no longer have a medical need to stay in hospital.

How will GPs and other community-based clinicians cope with the extra workload?

As mentioned above, the January national hospital discharge funding is to be spent not only on block bookings in care homes to take extra patients who’ve been speedily discharged from hospitals, but also on General Practice, mental health and Community Health services, among others, that will support the discharged patients to continue their recovery out of hospital.

But how are these already hard-pressed clinicians going to cope with yet more work?

NHS England’s Guidance is that the “additional clinical and therapeutic capacity” for the discharged patients can be purchased from NHS trusts, General Practice, virtual ward teams, community health services, voluntary sector organisations or the private sector. Support from volunteers may also be used.

This extra workload for GPs and Community Health services comes at a time when the Calderdale Adults Health and Social Care Scrutiny Board Detailed Review into General Practice has found that Calderdale GP Practices already have an increased workload (without extra resources being made available), as a result of taking the lead in the NHS recovery from Covid-19 and the recovery from the huge hospitals waiting lists for elective care.

In supporting the hospital with waiting lists and the post-pandemic backlog, Calderdale GPs are already doing a lot more work on patients’ referrals to hospital. The Detailed Review reports that hospital specialists are asking General Practice to carry out interventions or additional treatment or tests for their patients, that the hospital would have previously provided. This gives General Practice “greater levels of work and extended clinical responsibility than would have previously been expected” from them.

In addition, as there are up to 6 months waiting lists, or longer, for many specialities, before their operations patients are contacting their GPs due to pain, and questions on when their operation will be, which General Practice staff can’t answer.

More generally, the Councillors Detailed Review says that the level of trained clinical staff and communication between secondary and primary care have not kept pace with the former Calderdale Clinical Commissioning Group’s long-term policy of delivering “Care Closer to Home.” But this shift of services out of hospital into primary and community health services continues to be key to ongoing plans to transform Calderdale and Greater Huddersfield NHS and social care services.

There is some doubt that the national discharge fund will be able to secure care beds

One Integrated Care System director has told the Health Service Journal some peers did not believe they would secure care beds, and would instead look to use the funds to block-book hotels.

This is what Calderdale Council did in the first wave of Covid-19, when it contracted a number of beds from Cedar Court Hotel for patients who required social, rather than residential or nursing care.

The Health Service Journal reports that funding will be held by NHS England, and integrated care boards will claim what they spend up to their total allocation value.

It also states that the £200m comes from the Department of Health and Social Care’s existing revenue allocation. It is not new money provided by the Treasury.

Updated 18 Jan to clarify that the national discharge fund also covers extra clinical and therapeutic care of patients discharged into care homes, to help their recovery and rehabilitation.

Update 10 Feb

New NHS data show more than a third of delayed discharges are associated with NHS factors, not social care issues

Health Service Journal analysis of new NHS hospital discharge data – released in response to a Freedom of Information request – shows that although delayed discharges from hospital are often blamed on issues around social care, figures for the nine months to January 2023, for patients who have been in hospital for at least 21 days, suggest that around 35% are due to NHS-related delays.

The most common reason is waiting for rehabilitation beds in a community hospital or similar facility, which accounts for 23 per cent of total delayed discharges, based on daily averages.

Here is the Health Service Journal breakdown of causes of delayed hospital discharge

Update 23 Feb 2023

West Yorkshire delayed discharges have risen by more than 10% since the mid-January delayed discharges funding was announced

According to a Health Service Journal report, West Yorkshire is one of eight integrated care systems where the number of “delayed discharge” patients have risen by more than 10 percent since the fund was announced. Across the whole of England,, total numbers of patients experiencing delayed discharge have barely changed since then, although in some integrated care systems, the numbers have fallen substantially.

West Yorkshire Integrated Care System told the Health Service Journal it was too early to judge the full impact of its interventions. It said its funding is being used to purchase “packages of care” capacity plus associated clinical support for people who no longer need to be in hospital.