Health and Social Care Bill – Hospital Discharge proposals: BASW England response

The proposals must give people the opportunity to be listened to, heard, and involved in making decisions about their care and treatment

Following the publication of the proposals set out in the Health and Social Care reform bill white paper “Integration and Innovation: Working together to Improve Health and Social Care for All”[1], the Health and Care Bill has now been published and received its second reading in parliament on 14 July 2021.[2]

BASW England is keen to set out an initial response. This will focus on the proposed change to the existing Care Act legislation and legal requirements in relation to hospital discharge and social care assessment responsibility, particularly Discharge to Assess proposals.

The Care Act 2014 presently outlines a clear responsibility of local authorities to work together with health partners to bring people to the centre of any decisions made, with the Wellbeing Principle forming a corner stone of the assessment process and provisioning of support and services. We have concerns that a local authority’s Care Act duty to integrate care and support provision with health provision to promote individual wellbeing may be compromised. The proposals for Discharge to Assess do little to promote Article 8 and 5 of the Human Rights Act or offer assurances as to how rights will be upheld. These were key concerns reported with the current Discharge to Assess arrangements implemented during the Covid-19 pandemic.

Echoing the findings of the Healthwatch and British Red Cross survey in October 2020[3], BASW England presently has several concerns about the experiences shared by people, the support available, safety and consistency in approach to those with eligible needs for care and support leaving acute care settings, based on this proposed consolidation of Discharge to Assess pathways. Clear accountability needs to be established within this process to ensure an individual’s rights and the opportunity to be listened to, heard, and involved in making decisions about care and treatment, are fundamental principles of this proposal in line with the principles of the Mental Capacity Act (2005[4]) and the right to respect for private and family life (Article 8). This article protects people’s autonomy and well-being which includes participating in decisions about care and treatment, setting discharge and recovery goals, the protection for people from psychological trauma or physical harm caused by premature or delayed discharge which can lead to serious distress or hinder recovery. 5]

Appropriate resourcing in terms of staff and services must be available to ensure individuals receive the right service at the right time that is appropriate to their needs.

A survey of Social Workers conducted in December 2020 involved in hospital discharges highlighted that the vital contribution of social work in the multidisciplinary team was being marginalised by the medicalisation of people’s journeys out of hospital. Most importantly, social workers felt that the voice of the individual was lost, indicating arrangements being made without consent or against people’s views and wishes. Social workers identified that the care and support arranged for people’s hospital discharge was often more restrictive e.g., not being supported to return home with care or equipment but being taken to a care home. The survey highlighted an increase in the number of people being discharged to 24- hour care settings, with restricted access to family, networks, and existing care resources. A key concern raised by social workers was the loss or reduction of the involvement of social workers skill set in hospital discharge and the ability to effect change at crucial decision-making points.

BASW England is calling for clarity of the hospital discharge responsibility, accountability and funding from 31 March 2021, the end date of the current guidance to end.[6] In addition, what this journey will look like for people, as well as security for the social care sector through these multiple transition points.

BASW England does not support the proposals for Hospital Discharge through the Discharge to Assess policy and operating model proposed by the white paper and now the bill for the following reasons:

  • Arrangements for people are being made without their consent.
  • A lack of clarity over whether individuals will have the opportunity to discuss their feelings and thus be able to make their own decisions is not clear currently.
  • Member concerns about the application of and adherence to the Mental Capacity Act and the Human Rights Act leading to the erosion of people’s human rights.
  • Loss of social work skills, role, identity, and the value of social work’s contribution.
  • Removal of the requirement for assessments and planning to be undertaken in hospital for people needing care on discharge (except where there are concerns about abuse and neglect).
  • Absence of the social model of care and support which looks beyond a person’s medical needs focussing on the barriers to independence ensuring the person gets the right support at the right time to maintain their independence, choice, and control.
  • Concerns about the availability of adequate community resources.
  • A lack of clarity about the review of the Discharge to Assess model which was due to take place on the 31st of March 2021. To date there has been no formal evaluation of this approach and therefore it is unclear how it will transition under the proposed legislation.

Share your views

BASW England is keen to hear views from members about the proposals outlined in the Health and Care Bill.

The Bill is available to read online, alongside its explanatory notes.

BASW England will be consulting further with members on the Discharge to Assess proposals, other aspects of the Bill and submitting evidence to the House of Commons Public Bill Committee ahead of the first hearing on 7 September 2021.

If you wish to share your views or find out more then please get in touch: england@basw.co.uk

[1] https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version

[2] https://publications.parliament.uk/pa/bills/cbill/58-02/0140/210140.pdf

[3]https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/20201026%20Peoples%20experiences%20of%20leaving%20hospital%20during%20COVID-19_0.pdf

[4]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/921428/Mental-capacity-act-code-of-practice.pdf

[5] https://www.bihr.org.uk/coronavirus-hospital-discharge

[6] https://www.gov.uk/government/publications/hospital-discharge-service-policy-and-operating-model/hospital-discharge-service-policy-and-operating-model