Report Status:
Formal
Date to Cabinet Member: 13 Nov 2003
City of Westminster
Decision-maker
Date
Title of Report
CABINET MEMBER
November
FOR SOCIAL SERVICES 2003
& HOUSING
Expenditure Plan for Delayed
Discharge Grant 2003/4 and local
arrangements for monitoring
implementation of the Delayed
Discharges Act
CLASSIFICATION:
Report of
FOR GENERAL RELEASE
Director of Social and Community
Services
Wards Involved
All Westminster Wards
Policy Context
To support people to live independently within their
homes or within a family.
Financial Summary
An increase in budgeted expenditure of £247,000 in
2003/04 is proposed, funded by additional
Government Grant.
1.
Summary
1.1
This report describes the local response to the Delayed Discharges Act 2003.
2.
Recommendations
2.1
That the arrangements for monitoring delayed discharge in Westminster be
endorsed.
2.2
That the expenditure plan for the Delayed Discharges Grant of 2003/4 be
endorsed.
3.
Background Information
3.1
The Community Care Delayed Discharges Act received Royal Assent in April
2003. The intention of the Act is to produce reduction in delayed transferred
of care from hospital. Local authorities and NHS Trusts are required to have
shadow arrangements in place for tracing and auditing delayed discharges
from October 2003. The actual payments for delayed discharges will not
begin until January 2004. The amount reimbursed for each patient delayed
for reasons associated with the Local Authority is £120 a day in London and
the South East and £100 in the rest of the country.
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3.2
The main provisions of the Act are that NHS bodies have a statutory duty to
notify Social Services of a patient’s likely need for Community Care Services
and their proposed discharge date. NHS Trusts must then supply a discharge
notification. Reimbursement is due if Social Services have not assessed
within three days of the assessment notification and arranged services within
one day of the discharge notification. NHS Trusts have a duty to identify the
patient’s local authorities of residence.
3.3
In addition since June 2003 as part of the same Act, Local Authorities have
been unable to charge for community care equipment and intermediate care.
This has resulted in a loss of revenue to Westminster City Council.
4.
Arrangements for Reimbursement in Westminster
4.1
In 2003-2004 Westminster City Council has been allocated £247,000 to
support the development of services to tackle delayed transfer care.
4.2
Reimbursement is only applicable to patients in NHS “acute” trusts. In
Westminster these people will be primarily in St Mary’s, University College,
Royal Free, St Thomas’s and Chelsea and Westminster Hospitals.
4.3
A Delayed Transfer of Care Steering Group has been set up across
Kensington and Chelsea and Westminster. This group has representation
from both Local Authorities, PCTs and Chelsea and Westminster and St
Mary’s Hospital. This group is overseeing the implementation of the
notification systems and putting in place arrangements for auditing delayed
discharges.
4.4
The group has agreed to appoint a part time project manager for the
implementation of reimbursement for a period of 1 year. This person will have
responsibility for developing simple unambiguous systems to support the
implementation of the legislation, develop communications for patients and
clinical and social care staff and develop the information system necessary for
implementing reimbursement.
4.5
The Director of Social and Community Services in Westminster City Council
has written to the Chief Executives of Westminster Primary Care Trust, St
Mary’s NHS Trust and Chelsea and Westminster NHS Trusts suggesting that
as a local health economy we agree the anticipated “reimbursement due” sum
and an investment plan for the sum. This will allow us to plan services to
divert patients from acute hospital care. The actual reimbursement, which
occurs, can then be called off against the sum invested.
4.6
Examples of the types of services, which could be part of these expenditure
plans, are:


Additional block contracts with nursing homes to ensure availability of
beds.
Additional community equipment to facilitate independence.
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

Extra funding for personal care packages.
Extra funding for occupational therapy services to prevent admission to
hospital.
4.7
Appended to this report are 3 forms which have been developed by North
West London Strategic Health Authority for use when there are notifications of
patients likely to need community care services and confirming discharge
dates for patients. The legislation will inevitably involve NHS Trusts and
Social Services in more administrative work. It is the intention of the Steering
Group to ensure that systems which are set up are not unnecessarily
bureaucratic but the requirements of the Government legislation around
documentation are quite specific and will require considerable additional work
in completing and responding to forms.
4.8
All organisations will need to undertake training for staff on the requirements
of the legislation and the necessary notifications. It is anticipated that this
may be especially problematic for NHS Trust with high levels of agency staff
and may require a change in the role of the discharge teams to facilitate this
process.
4.9
A snapshot of the levels of delayed discharges attributable to Local
Authorities on 15th August 2003 is as follows: St Mary’s NHS Trust no delays;
Chelsea and Westminster NHS Trust 3 people delayed; St Thomas’s 3 people
delayed.
4.10
This indicates a level of reimbursement likely to be required by Westminster
City Council.
4.11
Expenditure Plan for Delayed Discharges Grant 2003/4:
Extra Nursing Home beds
Extra funding for disability equipment to facilitate discharge
Extra funding for occupational therapy assessments
Contribution towards reimbursement implementation post
Part funding for administrative post at St Mary’s
Total
£70,000
£80,000
£75,000
£10,000
£12,000
£247,000
5.
Financial Implications
5.1
The expenditure plan proposals identified in paragraph 4.11 above represent
additional spending over approved 2003/04 budgets. The cost of these
proposals can, however be met from the additional grant allocation of
£247,000 (see paragraph 4.1).
5.2
There is a risk that the City Council will be liable for delayed discharge
payments to acute trusts outside the immediate area but the number of such
cases are expected to be so small that any financial consequences can be
contained within the overall Older Persons budget. The impact of the
additional spending financed by the new grant will also help minimise the
financial impact of any such areas.
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6.
Legal Implications
6.1
There are no legal implications arising from this report.
7.
Staffing Implications
7.1
The post will be jointly funded by Kensington Chelsea and Westminster Local
Authority using the Delayed Discharge Grant.
8.
Outstanding Issues
8.1
There are no outstanding issues arising from this report.
9.
Performance Plan Implications
9.1
This proposals supports the following Social and Community Services aims:


To support people to live as independently as possible within their homes
or within a family.
To assess and meet the needs of service users and their carers.
10.
Consultation
10.1
There has been consultation on the arrangements detailed in this report with
St Mary’s NHS Trust, Chelsea and Westminster NHS Trust, St Thomas’s NHS
Trust, Westminster PCT and Kensington and Chelsea PCT. All are in
agreement with the action plans in this report.
11.
Health and Safety Issues
11.1
There are no health and safety issues arising from this report.
12.
Co-operation with Health Authorities
12.1
The arrangements described in this report have been arrived at in cooperation with all local NHS partner organisations.
13.
Human Rights Act 1998
13.1
There are no particular Human Rights Act implications arising from this report.
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14.
Reason for the Decision
14.1
The report describes the legislation concerning reimbursement by Local
Authorities for delayed discharges. It outlines the proposed local response to
this legislation and the expenditure plan associated with the grant.
14.2
The financial implications paragraphs describe the possible financial liability to
Westminster City Council where there is full reimbursement to NHS Trusts for
delayed discharges.
IF YOU HAVE ANY QUERIES ABOUT THIS REPORT OR WISH TO
INSPECT ANY OF THE BACKGROUND PAPERS, PLEASE CONTACT
MARIAN HARRINGTON ON 020 7641 1940;
EMAIL ADDRESS mharrington@westminster.gov.uk;
FAX NUMBER 020 7641 3902
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…………………………………………………………………………………………
For completion by Cabinet Member
Declaration of Interest

I have no interest to declare in respect of this report
Signed ……………………………. Date ………………………………
NAME:

I have to declare an interest
State nature of interest ……..……………………………………………
………………………………………………………………………………..
Signed ……………………………. Date …………………………………
NAME:
(N.B: If you have an interest you should seek advice as to whether it is appropriate
to make a decision in relation to this matter.)
For the reasons set out above, I agree the recommendation(s) in the report entitled
Expenditure Plan for Delayed Discharge Grant 2003/04 and local arrangements
for monitoring implementation of the Delayed Discharges Act and reject any
alternative options which are referred to but not recommended.
Signed ………………………………………………
Cabinet Member for Social Services & Housing
Date …………………………………………………
If you have any additional comment which you would want actioned in connection
with your decision you should discuss this with the report author and then set out
your comment below before the report and this pro-forma is returned to the
Secretariat for processing.
Additional comment: …………………………………………………………………
………………………………………………………………………………………….
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………………………………………………………………………………………….
NOTE: If you do not wish to approve the recommendations, or wish to make an
alternative decision, it is important that you consult the report author, the Director of
Legal and Administrative Services, the Chief Financial Officer and, if there are
staffing implications, the Head of Personnel (or their representatives) so that (1) you
can be made aware of any further relevant considerations that you should take into
account before making the decision and (2) your reasons for the decision can be
properly identified and recorded, as required by law.
Note to Cabinet Member: Your decision will now be published and copied to
the Members of the relevant Overview & Scrutiny Committee. If the decision
falls within the criteria for call-in, it will not be implemented until five working
days have elapsed from publication to allow the Overview and Scrutiny
Committee to decide whether it wishes to call the matter in.
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