Read on Twitter
Granted this is not the most exciting of reading, but essential for anyone who may:
find themselves, or a member of their family in a NHS (England) hospital from 1st September
be responsible for supporting discharge
(Thread) https://www.gov.uk/government/collections/hospital-discharge-service-guidance
find themselves, or a member of their family in a NHS (England) hospital from 1st Septemberbe responsible for supporting discharge(Thread) https://www.gov.uk/government/collections/hospital-discharge-service-guidance
Few things to note in this:
Emphasis is heavily on rapid discharge & community assessment: moves most assessment post acute care into communities-piling pressure onto local authorities & CCGs
Free support available on discharge up to 6 weeks
Emphasis is heavily on rapid discharge & community assessment: moves most assessment post acute care into communities-piling pressure onto local authorities & CCGs
Free support available on discharge up to 6 weeks
The 6 week cut off in communities will become the new point of critical failure in system flow while agreements are reached about who
For people with complex needs this has been a historic battle ground of dispute and delay with inadequate CHC assessment capacity
For people with complex needs this has been a historic battle ground of dispute and delay with inadequate CHC assessment capacity
Guidance about COVID screening prior to care home entry doesnât make sense for care homes unable to support safe isolation
LA must find an alternative place of care curious as to what DHSC means by this
Donât think hotels/hostels will cut it for people needing complex care
LA must find an alternative place of care curious as to what DHSC means by this
Donât think hotels/hostels will cut it for people needing complex care
All of this moves attention away from hospitals towards the more diffuse & difficult to âmanageâ world of communities
It also has potential to shunt cost and dispute about care into already inadequately resourced parts of the system leaving CCGs and LAs to go figure
It also has potential to shunt cost and dispute about care into already inadequately resourced parts of the system leaving CCGs and LAs to go figure
This deeply concerning for people with complex care needs those with significant functional & cognitive needs & their families
None of it recognises that shifting boundaries without substantial new resourcing will do anything useful to fix historic problems with long term care
None of it recognises that shifting boundaries without substantial new resourcing will do anything useful to fix historic problems with long term care
Meanwhile the new âcriteria to resideâ assessed twice daily will become the new hospital mantra
The Criteria to Reside are heavily skewed towards critical & procedural care-yet the majority of people needing longer stays in hospital do not get anywhere near critical care or procedures
Mostly they are older with acute frailty syndromes where things are much less cut & dried
Mostly they are older with acute frailty syndromes where things are much less cut & dried
If nothing else- rigidly enforced & performance managed Criteria to Reside could drive older people & those with complex conditions, especially delirium into their communities having been inadequately assessed
This winter we need to look out carefully for rising NHS readmissions
This winter we need to look out carefully for rising NHS readmissions
Data collection/performance management of the Criteria to Reside will be on a par with the ED 4 hour data industry
How good are your electronic data systems? Most hospital EPR & patient administrative data systems will struggle with the daily data requirements set out here
How good are your electronic data systems? Most hospital EPR & patient administrative data systems will struggle with the daily data requirements set out here
Make no mistake-there WILL be considerable centralised performance management for hospitals and systems of the new Discharge Guidance
Delving deeper into this Iâm wondering where the discharge funding âGovernment has agreedâ is going to come from 
Itâs pretty obvious that some of the original @AgeingWellNHS programme which was a #NHSLongTermPlan commitment just over a year ago has been recycled into this
Itâs pretty obvious that some of the original @AgeingWellNHS programme which was a #NHSLongTermPlan commitment just over a year ago has been recycled into this
And what now for the Better Care Fund which appears to be parked in planning terms but @NHSEngland has been keen to redeploy even as we developed the #nhslongtermplan?
https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/
https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/
@threadreaderapp unroll
As a post script to this the new Who Pays guidance covering commissioning responsibilities in England is an even more challenging read. The most important parts are however set out in para 14
https://www.england.nhs.uk/wp-content/uploads/2020/08/Who-Pays-final-24082020-v2.pdf
https://www.england.nhs.uk/wp-content/uploads/2020/08/Who-Pays-final-24082020-v2.pdf
Helpfully this does clarify some historically disputed issues relating to CCG responsibilities
In the main these revert to the CCG in which sits the GP with whom a patient was registered at the start of an episode
So far so good then.. (thereâs a BUT coming..)
In the main these revert to the CCG in which sits the GP with whom a patient was registered at the start of an episode
So far so good then.. (thereâs a BUT coming..)
BUT in March 2020 @NHSEngland instructed hospitals to free hospital capacity to deal with the COVID pandemic
In the scramble some patients may have ended up in care homes out of area
Thereâs a balanced review this in the following long read
https://nhsproviders.org/media/689544/spotlight-on-recent-nhs-discharges-into-care-homes.pdf
In the scramble some patients may have ended up in care homes out of area
Thereâs a balanced review this in the following long read
https://nhsproviders.org/media/689544/spotlight-on-recent-nhs-discharges-into-care-homes.pdf
There were already significant CHC eligibility assessment & review backlogs in England prior to COVID
With ongoing sporadic lockdowns & restrictions on care homes visiting, assessment of CHC eligibility is likely to be even more challenging https://caretobedifferent.co.uk/key-areas-of-concern-for-those-in-need-of-chc-funding/
With ongoing sporadic lockdowns & restrictions on care homes visiting, assessment of CHC eligibility is likely to be even more challenging
https://caretobedifferent.co.uk/key-areas-of-concern-for-those-in-need-of-chc-funding/
While the backlog for standard Continuing Health Care eligibility assessment had fallen over the last year, as we entered the first phase of the pandemic it was starting to go up again
By end of Q3 2019/20 ~1850 were waiting with 70% waiting >2 weeks
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/02/CHC-and-FNC-Report-Q3-2019-20_z5qnTp.pdf
By end of Q3 2019/20 ~1850 were waiting with 70% waiting >2 weeks
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/02/CHC-and-FNC-Report-Q3-2019-20_z5qnTp.pdf
Under the Who Pays @NHSEngland guidance payment responsibilities now revert from the CCG where a residential care provider is based (the March 2020 guidance) to the CCG responsible for care at the point of hospital discharge:
There are a few big issues for CCGs here:
Historic and new CHC assessment backlogs
COVID care home visitor restrictions
1st Sept discharge guidance rules
Non-COVID hospital demand is already rising
A hard cut off for clearing backlog and disputes by 31st December
Historic and new CHC assessment backlogsCOVID care home visitor restrictions 1st Sept discharge guidance rulesNon-COVID hospital demand is already risingA hard cut off for clearing backlog and disputes by 31st December
