NHS England releases hospital discharge fund guidance to ICBs

New guidance has been issued by NHS England to integrated care boards (ICBs) about how they should use recent hospital discharge funding to free up vital bed space in England.

It explains how ICBs, the legally constituted leadership and governing bodies for integrated care systems (ICSs), should use the £200 million discharge fund that was announced on 9 January 2023.

The funding will help local areas to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up beds for those who need them. The investment aims to support improved discharge performance, patient safety, experience, and outcomes.

Through the £200 million funding, ICBs are expected to deliver reductions in the number of patients who do not meet the criteria to reside in hospital but continue to do so, as well as improvements in patient flow which in turn help waiting times in emergency departments and handover delays.

The guidance importantly states: “This funding should be used to purchase bedded step down capacity plus associated clinical support for patients with no criteria to reside but who cannot be discharged with the capacity available through existing funding routes or the Adult Social Care £500m Discharge Fund announced previously.”

These arrangements apply to care delivered to patients up to and including 31 March 2023. Care delivered after that date, including for patients discharged up to and on 31 March 2023, will need to be funded from existing budgets, for example using the £500 million Adult Social Care Discharge Fund.

“This fund will pay for up to four weeks of a new or extended package of care at the point of discharge from an inpatient bed for patients who no longer meet the criteria to reside in their inpatient bed,” continues the guidance. “It will also pay for any clinical advice or therapeutic interventions in a step down facility to support the patient’s recovery, reconditioning, or rehabilitation, to optimise their outcome in advance of discharge from the step down facility.”

NHS England emphasises that ICBs should commence the actions required to deliver this additional capacity immediately.

Funding details and allocations

The £200 million fund is designed to cover ICBs’ costs of additional capacity for post-discharge care. This capacity must be over and above capacity already being funded by ICBs and systems.

Each ICB has been set a capped budget based on the weighted population formula. The full list of ICB funding allocations can be read here. The £200 million discharge funding will be held centrally by NHS England. ICBs will be reimbursed based on their actual spend up to the level of the capped budget.

Importantly, ICBs should determine the most appropriate route to deliver additional hospital discharge capacity in their area. This could include pooling funding with local authorities using existing statutory mechanisms. In all cases, arrangements for procuring additional bedded capacity should be made with the full involvement of local authority partners, taking account of wider pressures on the care market.

In addition, if an ICB thinks it will not be able to use all its allocated discharge funding, it should alert the regional discharge lead. NHS England reserves the right to reallocate some of the budget to other ICBs.

Patient eligibility and care

Any patient not meeting the criteria to reside in an acute hospital bed with additional or new care needs but unable to access care at home services should be considered for placement in a step down bed.

Patients in mental health inpatient units and non-acute inpatient settings who are clinically ready for discharge but awaiting assessment or decision about their longer-term care package should also be considered for a step down placement under this scheme where appropriate, according to NHS England.

All patients should receive a date of when they will return to their usual place of residence within four weeks with appropriate medical oversight, the guidance says. All care that patients receive must be adequate for ensuring improved functional and health outcomes.

Using the discharge funding within and outside of the four-week discharge period

NHS England highlights that most of the funding should be used to block book capacity to be used by patients during their first four weeks of care following discharge. However, ICBs should only block book capacity where they are confident that it will all be required and used by patients.

The guidance adds: “ICBs must work with local authorities to ensure that an appropriate, locally benchmarked, rate is paid for care funded through these arrangements, with rates set at a level that does not lead to local inflation in the cost of care.

“It is expected that assessments of ongoing health and care needs take place within four weeks of discharge and that a decision is made about how ongoing care will be funded by this point.”

In the rare circumstance that a patient’s care requirements and funding routes have not been determined within the four-week period, the £200 million fund must not be used to cover the cost of care beyond that point. After the four week-period, NHS and local authorities must cover care costs from within existing budgets.

Where an existing local arrangement is in place to agree who funds care while assessments are taking place, then the local authority and the ICB, if they both agree and if it is affordable within existing budgets, may choose to continue with this local funding arrangement beyond the four-week period, NHS England says.

In the absence of an existing locally agreed approach, the default is that costs are allocated according to what point in the assessment process has been reached by the end of the four weeks of care, as follows:

• Where the NHS continuing healthcare (CHC) or funded nursing care (FNC) assessments are delayed, the ICB remains responsible for paying until the NHS CHC/FNC assessment is done.
• Where there is no NHS CHC or FNC assessment delay, responsibility for funding sits with the local authority in line with existing procedures until the Care Act assessment is completed, after which normal funding routes apply.

The £200 million discharge funding does not cover long-term care needs following completion of a Care Act and/or NHS CHC assessment; social care or NHS CHC packages that are restarted following discharge from hospital at the same level as that already delivered prior to admission to hospital; or pre-existing (planned) local authority or ICB expenditure on discharge services.

Patient tracking

ICBs should ensure that patients are actively monitored throughout their stay in any additional capacity purchased through this scheme.

They will also be required to report on key indices of activity, with the majority of these collected daily.

Although NHS England says that further details about how ICBs will be required to report on patient activity will be communicated “in the coming days”, ICBs will are expected to monitor the number of step down beds purchased using the funding; number of patients from each inpatient bed moved today into a step down bed purchased using the funding, the duration of package, and the discharge pathway; and number of discharges from step down beds and the destination of patient.