Choosing home: discharge to assess and the Health and Care Act 2022

Abstract

In the early stages of the coronavirus pandemic National Health Service hospitals were instructed to rapidly discharge patients from wards with consequences which, in the case of some care homes, has been claimed to be catastrophic due to lack of effective testing and isolation. These tragic events also highlight a longer-term issue, namely hospital discharge policies and their relationship with obligations placed on local authorities to assess needs of individuals under the Care Act 2014. Concerns have been expressed for some time regarding the delays in getting patients discharged from hospitals – with them being labelled inappropriately as ‘bed blockers’. The Health and Care Act 2022 includes new statutory measures concerning discharge to facilitate rapid discharge of patients from hospitals. This can be seen as a solution to a major resource problem, but could this ultimately undermine choice and respect for individual wellbeing?The article explores the background to the recent controversies concerning hospital discharge decisions and their relationship with the Care Act 2014. It demonstrates that, while the current debates and controversies regarding hospital discharge decisions are nothing new and pre-date the pandemic by decades, hospital discharge processes accelerated during the pandemic and have left a problematic legacy. It interrogates the Health and Care Act 2022 discharge provisions and whether these will be an effective integration of health and social care provision going forward or whether there is a real risk of undermining individual autonomy, the Care Act 2014 obligations concerning promotion of well-being and a person’s choice of their ‘home’.