Carrot and sticks? The Community Care Act (2003) and the effect of financial incentives on delays in discharge from hospitals in England.
BACKGROUND
The belief that many delays in discharge from hospital were caused by social service departments (SSDs) led to the Community Care Act 2003 giving NHS hospitals in England the power to charge SSDs.


METHODS
We surveyed 150 SSDs in England about the implementation of the Act and used routine data to analyse trends in the number of delayed discharge patients; the number and cause of delayed discharge bed days by sector; and the proportion of inpatient bed days that consisted of delayed discharges.


RESULTS
Most hospitals opted not to charge SSDs for delays. Almost two thirds of SSDs (62%) made no payment of any kind to an acute hospital in 2004/05 and 2005/06, preferring to work collaboratively. The fall in number of 'delayed discharge patients' is a long term trend which precedes the implementation of the 2003 Act. Delayed discharge bed days accounted for 1.58% of all inpatient bed days in 2004/05. Contrary to popular opinion, the NHS accounted for two thirds (67%) of bed day delays, lack of suitable alternative NHS provision and services is a key factor. Patients are being discharged in greater numbers and earlier in their post-acute recovery phase. There are however questions about the quality and safety of early discharge. For example, emergency hospital readmissions rates have risen from 5.4% in 2002/03 to 6.7% in 2005/06, and patient dissatisfaction is significant.


CONCLUSIONS
Although delays in discharge from acute hospital beds have fallen, the quality of discharge and the capacity of Primary Care Trusts (PCTs) and SSDs to ensure appropriate and adequate post-discharge care is not as it should be. Contrary to popular perception, social services delays are of less significance than delays attributable to the NHS. There is no evidence to support government policy of charging SSDs for delay. Other factors, including NHS provision, are important, and a comprehensive overview of health and social care is vital.
McCoy
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D
Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
Godden
S
S
Pollock
A M
AM
Bianchessi
C
C
D000359:Aftercare / Q000331:legislation & jurisprudence; D001509:Bed Occupancy / Q000706:statistics & numerical data; D003153:Community Health Services / Q000331:legislation & jurisprudence*; D005249:Fees and Charges / Q000331:legislation & jurisprudence*; D005377:Financial Management, Hospital; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D010351:Patient Discharge / Q000191:economics* / Q000331:legislation & jurisprudence; D019984:Quality Indicators, Health Care; D012947:Social Work / Q000191:economics* / Q000592:standards; D013222:State Medicine; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom