Care Act sched 3 Hospital discharge

SCHEDULE 3 – DISCHARGE OF HOSPITAL PATIENTS WITH CARE AND SUPPORT NEEDS

 

Cases where hospital patient is likely to have care and support needs after discharge

 

1          (1)        Where the NHS body responsible for a hospital patient considers that it

Is not likely to be safe to discharge the patient unless arrangements for meeting the patient’s needs for care and support are in place, the body must give notice to—

 

(a)        the local authority in whose area the patient is ordinarily resident, or

(b)        if it appears to the body that the patient is of no settled residence, the local authority in whose area the hospital is situated.

 

(2)        A notice under sub-paragraph (1) is referred to in this Schedule as an

“assessment notice”; and the local authority to which an assessment notice is

given is referred to in this Schedule as “the relevant authority”.

 

(3)        An assessment notice—

 

(a)        must describe itself as such, and

(b)        may not be given more than seven days before the day on which the patient is expected to be admitted to hospital.

 

(4)        Before giving an assessment notice, the NHS body responsible for the

patient must consult—

 

(a)        the patient, and

(b)        where it is feasible to do so, any carer that the patient has.

 

(5)        An assessment notice remains in force until—

 

(a)        the patient is discharged (whether by the NHS body responsible for the patient or by the patient himself or herself),

(b)        the patient dies, or

(c)        the NHS body responsible for the patient withdraws the notice by giving a notice (a “withdrawal notice”) to the relevant authority.

 

(6)        A reference in this paragraph to a hospital patient includes a reference to a person who it is reasonable to expect is about to become one.

 

 

Assessment notice given by responsible NHS body to local authority

 

2          (1)        The NHS body responsible for a hospital patient, having given the

Relevant authority an assessment notice, must—

 

(a)        consult the authority before deciding what it will do for the patient in order for discharge to be safe, and

(b)        give the authority notice of the day on which it proposes to discharge the patient.

 

(2)        A notice under sub-paragraph (1)(b) is referred to in this Schedule as a

“discharge notice”.

 

(3)        A discharge notice must specify—

 

(a)        whether the NHS body responsible for the patient will be providing or arranging for the provision of services under the National Health Service Act 2006 to the patient after discharge, and

(b)        if it will, what those services are.

 

(4)        A discharge notice remains in force until—

 

(a)        the end of the relevant day, or

(b)        the NHS body responsible for the patient withdraws the notice by giving a withdrawal notice to the relevant authority.

 

(5)        The “relevant day” is the later of—

 

(a)        the day specified in the discharge notice, and

(b)        the last day of such period as regulations may specify.

 

(6)        A period specified under sub-paragraph (5)(b) must—

 

(a)        begin with the day after that on which the assessment notice is given, and

(b)        last for a period of at least two days.

 

 

3          (1)        The relevant authority, having received an assessment notice and

having in light of it carried out a needs assessment and (where applicable) a carer’s assessment, must inform the NHS body responsible for the patient—

 

(a)        whether the patient has needs for care and support,

(b)        (where applicable) whether a carer has needs for support,

(c)        whether any of the needs referred to in paragraphs (a) and (b) meet the eligibility criteria, and

(d)        how the authority plans to meet such of those needs as meet the

eligibility criteria.

 

(2)        Where, having carried out a needs assessment or carer’s assessment in a case within section 27(4), the relevant authority considers that the patient’s needs for care and support or (as the case may be) the carer’s needs for support have changed, it must inform the NHS body responsible for the patient of the change.

 

 

Cases where discharge of the patient is delayed

 

4          (1)        If the relevant authority, having received an assessment notice and a

discharge notice, has not carried out a needs or (where applicable) carer’s assessment and the patient has not been discharged by the end of the relevant day, the NHS body responsible for the patient may require the relevant authority to pay the specified amount for each day of the specified period.

 

(2)        If the relevant authority has not put in place arrangements for meeting some or all of those of the needs under sections 18 to 20 that it proposes to meet in the case of the patient or (where applicable) a carer, and the patient has for that reason alone not been discharged by the end of the relevant day, the NHS body responsible for the patient may require the relevant authority to pay the specified amount for each day of the specified period.

 

(3)        If, in a case within sub-paragraph (1) or (2), the assessment notice ceases to be in force, any liability arising under that sub-paragraph before it ceased to be in force is unaffected.

 

(4)        A payment under sub-paragraph (1) or (2) must be made to—

 

(a)        the NHS body responsible for the patient, or

(b)        in such a case as regulations may specify, the person specified.

 

(5)        The “relevant day” has the meaning given by paragraph 2(5).

 

(6)        A reference to a requirement to pay the specified amount is a reference to a requirement to pay the amount specified in regulations; and the reference to the specified period is a reference to the period specified in or determined in accordance with regulations.

 

(7)        In specifying the amount of a payment, the Secretary of State must have regard in particular to either or both of—

 

(a)        costs to NHS bodies of providing accommodation and personal care to patients ready to be discharged, and

(b)        costs to local authorities of meeting needs under sections 18 to 20 in the case of persons who have been discharged.

 

 

Delegation to management of independent hospital

 

5          (1)        An NHS body may make arrangements with any person connected

with the management of an independent hospital for that person (or an employee of that person) to do, on behalf of the NHS body and in accordance with the arrangements, anything which is required or authorised to be done by the NHS body by or under this Schedule in relation to hospital patients accommodated in that hospital.

 

(2)       Anything done or omitted to be done by or in relation to the authorised

person (or an employee of that person) under such arrangements is to be treated as done or omitted to be done by or in relation to the NHS body.

 

(3)        Nothing in this paragraph prevents anything being done by or in relation to the NHS body.

 

 

Adjustments between local authorities

 

6          (1)        Regulations may modify, or otherwise make provision about, the

application of a provision of this Schedule in a case where it appears to the NHS body responsible for a hospital patient that the patient is ordinarily resident in the area of another local authority.

 

(2)        The regulations may, in particular, authorise or require a local authority—

 

(a)        to accept an assessment notice given to it even though it may wish to dispute that it was the correct authority to which to give the notice;

(b)        to become the relevant authority in the patient’s case;

(c)        to recover expenditure incurred—

 

(i)         in the exercise of functions under this Schedule;

(ii)        in meeting needs under sections 18 to 20 in a case under this Schedule.

 

 

Meaning of “hospital patient”, “NHS hospital, “NHS body”, etc.

 

         (1)        A hospital patient is a person ordinarily resident in England who—

 

(a) is being accommodated at an NHS hospital, or at an independent

hospital as a result of arrangements made by an NHS body, and

(b) is receiving (or has received or can reasonably be expected to receive)

acute care.

 

(2)        “NHS hospital” means a health service hospital (as defined by the National Health Service Act 2006) in England.

 

(3)        “Independent hospital” means a hospital (as defined by that Act) in the

United Kingdom which is not—

 

(a)        an NHS hospital,

(b)        a health service hospital as defined by section 206 of the National Health Service (Wales) Act 2006,

(c)        a health service hospital as defined by section 108 of the National Health Service (Scotland) Act 1978, or

(d)        a hospital vested in the Department of Health, Social Services and Public Safety in Northern Ireland or managed by a Health and Social Care trust.

 

(4)        “NHS body” means—

 

(a)        an NHS trust established under section 25 of the National Health Service Act 2006,

(b)        an NHS foundation trust,

(c)        the National Health Service Commissioning Board, or

(d)        a clinical commissioning group.

 

(5)        A reference to the NHS body responsible for a hospital patient is—

 

(a)        if the hospital is an NHS hospital, a reference to the NHS body

managing it, or

(b)        if the hospital is an independent hospital, a reference to the NHS body that arranged for the patient to be accommodated in it.

 

(6)        “Acute care” means intensive medical treatment provided by or under the supervision of a consultant, that lasts for a limited period after which the person receiving the treatment no longer benefits from it.

 

(7)        Care is not “acute care” if the patient has given an undertaking (or one has been given on the patient’s behalf) to pay for it; nor is any of the following “acute care”—

 

(a)        care of an expectant or nursing mother;

(b)        mental health care;

(c)        palliative care;

(d)        a structured programme of care provided for a limited period to help a person maintain or regain the ability to live at home;

(e)        care provided for recuperation or rehabilitation.

 

(8)        “Mental health care” means psychiatric services, or other services provided for the purpose of preventing, diagnosing or treating illness, the arrangements for which are the primary responsibility of a consultant psychiatrist.

 

 

Further provision about assessment notices, discharge notices, etc.

 

8          Regulations may—

 

(a)        specify the form and content of an assessment notice, a discharge

notice or a withdrawal notice;

(b)        specify the manner in which an assessment notice, a discharge notice

or a withdrawal notice may be given;

(c)        specify when a discharge notice may be given;

(d)        specify circumstances in which a withdrawal notice must be given;

(e)        make provision for determining the day on which an assessment

notice, a discharge notice or a withdrawal notice is to be regarded as

given.

 

 

 

The Government’s Explanatory Notes to the Bill for this Act say as follows:

 

“Schedule 3 re-enacts the effect of the delayed discharges provisions of the Community Care (Delayed Discharges etc) Act 2003 (the 2003 Act) and relevant regulations, subject to simplification and amendments to fit the new NHS architecture. The Schedule deals with the planning of safe discharge of patients in England from NHS hospital care, or hospital care arranged for by the NHS, to local authority care and support to ensure that patients are not delayed in hospital despite being fit, safe and ready to be discharged.

 

 

Cases where hospital patient is likely to have care and support needs after discharge

 

Paragraph 1 places responsibility on the NHS body to inform the relevant local authority of a patient’s likely need for care and support. This is known as an ‘assessment notice’ and is necessary when the patient is unlikely to be safely discharged from hospital without arrangements for care and support being put into place first. The relevant local authority who the NHS body must notify is the one in which the patient is ordinarily resident or, if it is not possible to determine ordinary residence, the local authority area in which the hospital is situated.

 

The paragraph sets out a number of requirements for the assessment notice:

 

The notice must state that it is given under this provision. This is so that the local authority is aware of the consequences that could flow from the assessment notice, such as the liability to pay the NHS body for the costs of delayed discharge arising under paragraph 4 of this schedule.

 

The notice should not be issued more than 7 days before the patient is expected to be admitted into hospital. This is so the notice is not provided too far in advance of admission to avoid the risk of wasting preliminary planning in the event the patient’s condition changes.

 

The responsible NHS body must consult with the patient and, where appropriate, the carer before issuing the assessment notification. This is to avoid unnecessary assessments where, for example, the patient wishes to make private arrangements for care and support.

 

These requirements replicate provisions set out in sections 2 and 3 of the 2003 Act and regulation 4(4) and (5) of the Delayed Discharges (England) Regulations 2003 (S.I. 2003/2277).

 

 

Assessment notice given by responsible NHS body to local authority

 

Paragraph 2 sets out the process that the responsible NHS body and relevant local authority must follow to ensure a patient with care and support needs can be safely discharged from hospital.

 

There are certain legal obligations that are activated by the discharge of the patient from NHS care. When such a decision has been made and the patient has (or may have) care and support needs, then a safe discharge cannot occur until the NHS and local authority are satisfied that, as sub-paragraph (1) sets out, the patient is ready for discharge and that it is safe for them to be discharged. The NHS body has to give the local authority notice of when it intends to discharge the patient. This is known as a discharge notice.

 

Sub-paragraph (3) provides that the discharge notice must specify whether or not the patient will receive any further health care services upon discharge, and if so, what those services will be.

 

Sub-paragraph (5) sets out the definition of the ‘relevant day’ until which a discharge notice remains in force. This is relevant to defining any delayed discharge period in the event that the local authority is held to be liable under paragraph 4 to pay the NHS body for the cost of accommodation or personal care caused by the delayed discharge from hospital. The ‘relevant day’ would either be the day specified in the discharge notice or the end of a period which regulations may set out.

 

This replicates the provisions set out in section 5 of the 2003 Act and regulation 5 of the Delayed Discharges (England) Regulations 2003 (S.I. 2003/2277).

 

Paragraph 3 sets out the responsibilities of the local authority who received an assessment notice. The local authority must carry out an assessment of the patient’s need and, where applicable, the carer’s need, with a view to identifying the care and support that is necessary for them to be safely discharged. The local authority must inform the NHS of the outcome of the assessment.

 

This replicates the provisions in section 4 of the 2003 Act.

 

 

Cases where the discharge of the patient is delayed

 

Paragraph 4 sets out what is to happen if the discharge of the patient is delayed because the local authority has not carried out the relevant care and support assessments or put the required package of care and support in place.

 

Sub-paragraph (2) provides that the local authority is liable to make payments to the responsible NHS body for each day that a patient is unable to be discharged.

 

Regulations will be introduced to set out:

 

  • how the delayed discharge period is to be calculated; and
  • the amount to be paid.

 

This section replicates provisions set out in sections 6 and 7 of the 2003 Act.

 

 

Delegation to management of independent hospital

 

Paragraph 5(1) provides that an NHS body may make arrangements with others for the person to do anything which is required or authorised to be done by the NHS body under this Schedule. Sub-paragraphs (2) and (3) set out the effect of such an arrangement.  This replicates sections 1(3), (4) and (5) of the 2003 Act.

 

 

Adjustments between local authorities

 

Paragraph 6 allows for regulations to be made to modify the provisions relating to delayed hospital discharges where it appears to the NHS body that the patient is ordinarily resident in the area of another local authority. This might require the local authority to accept assessment notices even in cases where it may wish to dispute that it is the relevant local authority. The regulations may also enable the local authority to recover relevant expenditure that it incurs.  This re-enacts section 10 of the 2003 Act.

 

 

Meaning of “hospital patient”, “NHS hospital”, “NHS body”, etc.

 

Paragraph 7 sets out the meaning of a number of terms relating to the delayed discharges regime in Schedule 3.”

 

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