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Is constant new legislation preventing us doing our job?

Lynn Young

There once was a time when the dear old NHS suffered the imposition of new primary legislation every 20 years or so. This, readers, is not the current state of affairs. Since April 1999 the NHS has had to suffer the onslaught of radical new legislation each year, and 2002 was no exception.
At the time of going to print yet more healthcare legislation is wending its way through the parliamentary process in the form of the Community Care (Delayed Discharge) Bill. Thankfully, the legislation is a mere eight pages long, but, without exception, all organisations involved in the consultation were opposed to this action. Are we experiencing a decline in democratic behaviour from our beloved government? Consultation is a wonderful thing when voices are heard and acted upon. In this case we all spoke, indeed sang from the same hymnsheet, but the government decided to get cracking with implementation anyway!
So what does this proposed new legislation mean for patients and nurses? The Bill applies to England and Wales only. It will introduce a system whereby each time a delayed hospital discharge occurs that is deemed to be the fault of the local authority (LA), the LA will have to pay a sum of money to the hospital.
Such a system has been operating for some years in Sweden and has led to improvements in the quality and speed of hospital discharge. English and Welsh Ministers are obviously impressed, but many of us have concerns about any new arrangements that could cause added conflicts between the health- and social care sectors.
There is, however, some good news. It looks likely that in certain circumstances new powers will be put in place, that will remove the power of LAs to charge for certain care services. This might enable people to receive more services without being means tested - but further details on this are currently not available.
According to the evidence given to the Select Committee on delayed discharge (the RCN gave both oral and written evidence), there are currently 5,000 patients in hospital waiting to go home, simply because suitable care arrangements have not been organised. This could be a place within a nursing or residential care home, which is also a problem as a number of these are closing down.
The idea is that social service departments will have an added incentive to make a proper assessment of a patient's community care needs and ensure that the proper services are organised by the time the patient is fit to return home. This will help to ensure that the only reason people are occupying a hospital bed is because they are in need of intensive and/or medical care. When this fails the social service department will have to pay the hospital for the extra days the patient remains.
This is all very interesting, but also worrying. Penalties in themselves do not increase capacity, and many nurses tell me that delays are often caused because there are simply not enough frontline people to do the work! We certainly welcome the proposed extra money going into social service departments, but it might prove that all this added cash will go in fines, not in care. It is generally agreed that it is partnership that saves the day, and penalising one part of the care sector could threaten this. Cross-charging could lead to older people with complex needs being labelled as problem patients, when we are trying to challenge an attitude of ageism within the care system.
And another point. How many of you know about the new Freedom of Information Act? This demands that all publicly funded organisations have a document, freely available to users, that includes information about its finances, staff and services. Apparently a template will soon be on its way to you.
For the sake of all our health, 2003 needs to be a year without policy, directives, developments and legislation. We need time to reflect, sustain, implement and recover from constant turmoil. Are you listening, Mr Blair?