Thread by @runnermandoc

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)
gov.uk/government/col…

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 👇

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 👇

Guidance about COVID screening prior to care home entry doesn’t 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

Don’t 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 ‘manage’ 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 👇

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

*who pays that should be!

Meanwhile the new ‘criteria to reside’ 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

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

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👇

Make no mistake-there WILL be considerable centralised performance management for hospitals and systems of the new Discharge Guidance👇

Delving deeper into this I’m wondering where the discharge funding ‘Government has agreed’ is going to come from 🤔

It’s 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?👇

england.nhs.uk/ourwork/part-r…

@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 👇

england.nhs.uk/wp-content/upl…

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.. (there’s 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

There’s a balanced review this in the following long read👉

nhsproviders.org/media/689544/s…

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 👇

caretobedifferent.co.uk/key-areas-of-c…

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

england.nhs.uk/statistics/wp-…

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