Press release: Delivering for older people - NHSC, LGA and ADSS joint statement

14 Nov 2002

In the Queen's Speech the Government set out its plan to tackle delays in discharging older people from hospital in its community care (delayed discharges) bill, published on 14 November. The legislation follows proposals first published by the Government in April, following the 2002 budget announcement.

A real commitment
*  The LGA, NHS Confederation and ADSS share the Government's commitment to and aspiration to tackle the misery of delays in discharging older people from hospital. We are all committed to ensuring that older people receive appropriate care - both in and out of the hospital setting.

Building on partnership
*  Real progress has been made in forging partnerships between health and local government, including the particularly successful joint work to alleviate winter pressures. A recent Audit Commission report endorsed the successful partnerships already in place. We want to build on these to prevent unnecessary hospital admissions, reduce delayed discharges and provide integrated health and social care services. It would be a retrograde step if the current proposals undermined this trust and led to the development of adversarial relationships rather than cooperation between health and local government.

Costs
*  We have concerns about the costs of the proposals and their practical impact. These costs will be financial and human.

Councils in England and Wales, whose social services budgets are already substantially stretched and overspent, do not currently have the resources to fund the upfront costs of building additional capacity in a short space of time. Additional alternative provisions would need to be planned and implemented jointly with health services.

It would be regrettable if the proposed system of reimbursement led to a reduction in funding for older people's services in particular, and for vulnerable groups in general. The money must remain within the overall resources for older people and should be spent by joint agreement.

The Government's plan to introduce these measures within six months could cause significant practical difficulties on the ground. The Government's approach to charging is based on a model in use in Sweden, however, when the measures were introduced there, they were phased in over a two year period. Moreover, in Sweden the model was introduced into a system where local government¡¦s remit included both health and social care.

No single cause of delayed discharge
*  The current proposals focus on only one element of a complex and interdependent system. There is however no single cause for delays in discharge and no one sector can deliver a solution. Reasons for delays include inappropriate admission because of a lack of alternative provision, an older person waiting for a residential or nursing home placement, which is not controlled by local councils, a lack of funding in social services departments, a patient exercising choice, or a wait arising within the hospital because of delays in implementing appropriate discharge procedures,. Effective incentives need to focus on the entire patient pathway and across the whole system.

Joint targets and joint incentives
*  We believe that positive incentives could have an important role to play in encouraging further joint working, and that the key to delivering better services for older people is to develop a shared performance management framework which spans the whole system and covers all agencies. We need to ensure that any incentives regime is designed in a way that delivers demonstrably better services for older people, without unintended consequences for the local health and social care system. To be most effective, proposals should enhance services for older people and the partnerships between local government and the NHS

Such a system of incentives could only be implemented in the context of joint targets for health and social care, and a joint protocol between NHS Trusts, PCTs and local councils about how any money will be spent on services for older people.

A better way forward
*  The current system favours quick wins over long term, sustained, holistic improvement to services for older people. We want to work with Government to develop a policy based on a real understanding of the interaction and inter-dependence of the whole system.
*  If we are to deliver real improvements in patient care and access to services, we need to ensure that the current proposals reflect the need to include a system of incentives based on joint targets and a joint protocol, to ensure that the money is spent on older people, and to phase in the scheme with pilots.
*  We remain committed to a whole systems approach, which focuses on delivering the highest quality services for older people by preventing ill health, maintaining independence, avoiding unnecessary admissions as well as delivering the right care in the right setting when needed. This requires a partnership approach to redesign health and social care processes around the needs of individuals and a development in rehabilitation and residential care capacity together with realistic alternatives that help staff avoid admission wherever possible.

Notes for editors

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Contact details

Saffron Cordery, Senior Public Affairs Officer, Local Government Association, tel 020 7664 3252, e-mail saffron.cordery@lga.gov.uk

Judith Waxman, Parliamentary and Public Affairs Officer, NHS Confederation, tel 020 7959 7236, e-mail judith.waxman@nhsconfed.org

Drew Clode, Policy and Press Adviser, Association of Directors of Social Services, tel 020 8348 5023, e-mail drew@adss.demon.co.uk

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