Implementing the reinbursement scheme - views of health and social care staff in six high performing sites

The Community Care (Delayed Discharges) Act 2003 announced a new reimbursement scheme which was intended to accelerate the downward trend in rates of delayed discharges and strengthen joint working between acute health trusts and social services. Under the new scheme hospitals and social services were to agree new inter-agency discharge planning protocols and communication systems, and to operate new legal notification systems that required hospitals to give social services formal notification at least 3 days in advance of a patient’s planned discharge. Agencies were required to agree the numbers of delays each agency was responsible for each week, and acute trusts could charge local authorities for any delays for which they were responsible. Critics warned that the scheme was unsuited to the task, and that its implementation might put partnership working and patient care at risk.

This paper explores health and social care staff views on the early working of the reimbursement scheme taken from a broader study of the factors associated with low rates of delays in six sites where performance (in terms of rates of delayed discharge) was exceptionally good. Forty-three qualitative interviews were undertaken between June 2004 and March 2005 with a range of health and social care professionals responsible for, or involved in, discharge arrangements in the six sites.

For the majority of staff, the scheme has largely supported joint working; it provided substantial new funding to social services department for joint commissioning, it has required joint implementation of new interagency notification systems, and close monitoring and interagency communication around delays. Whilst those working with new notification systems have experienced some difficulties with reaching a shared understanding of what is required, the notification system appears to have supported clear and timely communication around discharge between ward and social services staff. Impacts on patients were not clear cut, but there were concerns from some social services staff that as a result of reimbursement, there was greater likelihood of ‘hurried’ discharges.

This paper offers important insights into the early working of the scheme in sites where agencies were already performing well in terms of delayed discharges. It should be of interest to those involved in implementing the reimbursement scheme or with a role in discharge arrangements.