Health and Care Bill: discharge
Updated 10 March 2022
© Crown copyright 2022
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-discharge
The West Lancashire Discharge to Assess model said:
Not only have we been able to support patients in leaving hospital and returning home safely and in a timely manner, we have also helped to keep hospital beds free for those who need it most by providing the right kind of care for people in the community.
This fact sheet explains how the government plans to enable local areas to adopt discharge processes that best meet local needs, including removing legislative barriers to the Discharge to Assess model.
Background
Since the Care Act 2014, the requirement to carry out long-term health and care needs assessments before discharge resulted in some individuals experiencing delayed hospital discharge as they waited for their assessment to be carried out. This meant the appropriate transfer of care could not take place when a person was ready to leave a hospital.
Delayed discharges can result in poorer outcomes for individuals, such as loss of independence, or functional decline such as muscle deterioration in people who are older or have dementia; additional expense to the NHS as people occupy beds without a clinical need; and more complex or higher levels of care on discharge due to the loss of function described above.
Discharging people as soon as they are clinically ready is increasingly recognised as the most effective way to support better outcomes. It reduces time in a hospital bed and supports people to remain independent at home wherever possible. This model is known in England as ‘Discharge to Assess’. Individuals recover in an environment that is familiar to them, while they receive care and reablement support in the community. Individuals are then assessed for their long-term health and care needs at a point of optimum recovery, allowing a more accurate evaluation of their needs.
What the Bill will do
This Bill repeals Schedule 3 to the Care Act 2014 (the Care Act). These provisions deal with planning hospital discharge for people in England from NHS hospital care to local authority care and support. Specifically, the Bill will repeal the requirements prescribing that local authorities carry out social care needs assessments while someone remains a hospital inpatient. This will create flexibility for local areas to adopt discharge processes that best meet the needs of the local population, including the Discharge to Assess model. It will also facilitate closer collaboration between health and social care systems and enable better outcomes for people following their stay in acute care. Through repealing Schedule 3, the system of discharge notices and associated financial penalties set out in the Care Act will also be removed.
This provision does not change existing legal obligations on NHS bodies to meet health needs, and local authorities are still required to assess and meet people’s needs for adult social care. Nor does it alter the thresholds of eligibility for continuing healthcare, funded nursing care or support through the Care Act.
How these provisions will help to promote integration
Introducing flexibility for local areas to adopt the discharge model that best meets local needs will promote integration by enabling better joint working and decision-making between NHS organisations (including acute and community health services) and social care stakeholders (such as local authorities and domiciliary and residential providers). For example, it will enable joint decision-making about the care an individual needs after discharge to support their recovery.
Empowering local areas to work together in ways that best support the needs of their local populations will enable them to deliver integrated health and social care services and improve people’s outcomes. Taking into account individuals’ preferences will enable people to live healthier and more independent lives for longer, for example by assessing them at their optimum point of recovery.
Case study – Joe’s story
It was identified that Joe, 84, needed support to regain his independence at home when he was discharged from hospital. The day Joe was discharged from hospital he was visited by a senior reablement worker and occupational therapist and a package of care totalling 31 hours of support a week was instigated.
Joe identified his goals. These included:
- being able to walk
- completing his personal care independently
- preparing his own meals
- using his stairlift to access the upstairs of his property
The council’s multi-disciplinary team worked jointly with NHS professionals and Joe, initially focusing on his mobility and personal care. As his confidence with mobility grew, reablement staff began to work on meal and drink preparation, but Joe still required occasional assistance with aspects of his personal care. A multi-disciplinary team meeting agreed a further week of reablement to progress this.
Following reablement support, Joe is now living independently in his own home, and does not need a long-term package of care.
Further information
Guidance on Hospital discharge service: policy and operating model