Since moving from a generic Community Care team into a specialist Mental Health team a few years ago, I haven’t had as much contact with the vagaries of the delayed discharge system as I did back then.
Yesterday was a rude (in every sense of the word) awakening.
The Community Care (Delayed Discharge) Act 2003 introduced procedures to speed along the process of hospital discharge from acute wards when beds were needed. The financial stick approach was favoured and social services become chargeable for people who remain in hospital for ‘social’ reasons. This prompted much fear within these self-same social services departments and moved possible and potential delayed discharges into the ‘highest priority’ category as the costs mount up exceptionally quickly (I can’t remember the exact costs now but it’s floats about £120 a day – am happy to accept corrections on that though.. it’s off the top of my head!).
There are also government targets relating to delayed discharge figures which tends to get people moving.
The process is now quite clear. We (social workers) receive a section 2 notification when or shortly after someone is admitted to hospital. This is a request for an assessment. Off we go and assess and put all the post-hospital plans into place – ready to go.
We then get sent a Section 5 notification. This is the one that kicks us into action. It usually means we have 24 hours to actually set up the systems we have put into place. It’s like a starting gun..
This system is not in place in psychiatric hospitals – yet – which is the reason I have less contact with it than before.
Sometimes things don’t work quite as smoothly as they should. It isn’t surprising. People are people after all and sometimes, to quote old Rabbie Burns (my (scottish) mother would be proud)
‘The best laid schemes o’ mice an’ men
Gang aft agley,’
This issue remains my highest point of contention with hospital staff. Sometimes Section 2s and Section 5s turn up on the same day for someone that needs a new care package (restarts are usually easy to set up, in contrast). Sometimes, you phone after receiving a Section 2 and ask about possible discharge plans to time things accordingly and get a ‘there are no plans to discharge X or Y’ and leaving a message, you go back to your work – only to have a Section 5 turn up on your desk a couple of hours later.
Sometimes when you move from a general adult service to a specialist mental health service and mutter about Mr I being issued with Section 2 notification, people gasp in horror about never thinking that he needed a compulsory admission.. oops, I should actually have made that clearer when I was discussing it with team members I think!
But yesterday, in responding to a Section 2 Community Care (Delayed Discharge) Act, I went to see Mr I in hospital. Not as local a hospital as it could be either. We were discussing care plans and discharges when one of the nursing staff spotted me (I’d told them I was coming so it would have probably been obvious who I was!).
‘Mr I is going to be discharged this afternoon’
‘Hold on, what about the Section 5 notification’
‘The ward manager is writing that now’
I look at Mr I. I have, fortunately (well, you learn a trick or two in time) spoken to the care agency that provides a ‘rapid response’ cover a couple of hours before I’d even left for the hospital to find out how quickly they could provide a service if needed.
‘I need 24 hours notice of a discharge to arrange a care package’.
Nurse furrows his brow. I lead a lecture about procedures and then realise that some fights aren’t worth pursuing.
I could probably have pushed it if I really wanted to but in this situation it really didn’t seem worth it. Sometimes though, righteous indignation feels quite self-satisfying.
A couple of phone calls and I have a care package ready to go for the evening and I got my little ‘procedures’ lecture in. I know I shouldn’t do it but sometimes (fortunately not in this case) that 24 hours really is crucial.