The £200 million hospital discharge fund – making it work

The Government made headlines earlier this month by committing an ‘additional’ £200 million funding to speed up patient discharge from hospital – tackling the problem often referred to as ‘bed-blocking’ by patients, frequently elderly, who are medically fit to be discharged but do not have support in place to return home, or a longer-term care placement arranged. 

Guidance released following the announcement confirms that the funding is a short-term measure available to Integrated Care Boards (ICBs) to fund placements of up to four weeks per patient until 31 March 2023. It is expected to be used by them to block book beds as step-down capacity and fund associated clinical support. Funds are being allocated to be used with immediate effect, to individual ICBs based on population size as opposed to being prioritised according to any assessment of which areas of the country need it the most. In addition to the £200 million a further £50 million capital funding has been committed to upgrade and expand hospitals to include new ambulance hubs and discharge lounges.

The impact that this additional funding will have depends very much on how it is used. 

• As an initial point, the allocation to ICBs based on population size rather than need, while pragmatic given the short timescales involved, may prove unhelpful. Within the guidance NHS England notes that regional leads may consider reallocation following discussion with ICBs regarding priority areas, and this is something which ICBs could usefully look to influence as soon as possible where it is clear funding might either not be needed or might not be capable of being used effectively within the timescale to the end of March 2023.
• Even more crucial to enable funds to be effectively deployed, is the involvement of the wider system and specifically Place (where ICBs have multiple places); those health and care organisations at a local level with real insight into local population needs, as soon as possible. This is flagged in the guidance which indicates that ICBs should use the most appropriate route to deliver capacity, including through varying, extending or amending existing section 75 agreements or the Better Care Fund arrangements. With ICBs only recently established, and still developing their operating models and interactions with Place based partnerships, this could prove challenging within the timescales. Many ICBs have not yet delegated much resource or decision-making to Place and may not yet have full visibility of Better Care Fund arrangements made at Place level where they have multiple Place-based Partnerships within their area.
• The capital funding included will only have an impact in the longer term given the time required to plan, procure and construct the relevant areas.
• Likewise, no matter how much money is allocated to support discharge of medically fit patients into social care settings in the short term, this will not solve issues relating to social care capacity where these are related to the ability of settings to staff extra beds. Social care staffing issues are also well publicised and need broader attention to address.
• ICBs also need to be mindful of procurement obligations, where applicable, in purchasing additional capacity. 

Tackling these issues to make best use of the funding requires immediate planning by ICBs and action to identify the best ways to get the funding to where it is most needed. In some instances, for example where staffing is a major issue, additional funding on its own may not be sufficient to deal with the problems of delayed discharge in the short term. ICBs with the strongest existing relationships with their Place partners will be best-placed to move swiftly, and it is unsurprising that two of the ‘National Discharge Frontrunners’ named in the 9 January announcement, Leeds and Sussex, are Place-based partnerships. 

Going forwards, announcements such as these underline the importance of ICBs continuing to work to develop their arrangements with system partners at Place and beyond to enhance their ability to react swiftly to developments like these and start to tackle broader long term issues affecting hospital discharge, for example in relation to system workforce.
 
Hill Dickinson works closely with ICBs, Place-based partnerships, and local authorities on many of the issues referred to in this article. Please contact us if you require more information or support.