Councils asked to identify ‘designated facilities’ for discharged patients

Local authorities have been asked to urgently identify “designated facilities” to manage any rapid discharge of hospital patients into care homes during a second wave of coronavirus.

A letter to the directors of adult services from the Department of Health and Social Care (DHSC) says patients with positive Covid-19 tests must be discharged into an “appropriate designated setting”.

These must be inspected by the Care Quality Commission (CQC) to ensure they meet the regulator’s infection control standards.

It says anyone discharged into a care home must have a test result which is communicated in advance to the residence.

Councils will be required to provide alternative accommodation for the resident to isolate in if a care home does not have appropriate facilities.

They have been asked to identify accommodation that could meet current and future winter demand and notify the CQC of these premises, “ideally” by Friday or as soon as possible.

According to the letter, the CQC is ready to approve 500 settings by the end of November, and will prioritise areas with the highest level of restrictions.

But care providers said the scheme was “severely lacking” in operational detail.

Vic Rayner, executive director at the National Care Forum, said: “Key questions around who will operate these services, how they will be staffed, what choice will patients have in relation to their discharge and critically how care for the multiplicity of needs will be managed in one setting appear to be still not settled.

“Within 48 hours local authorities are being asked to identify these schemes – and then a rapid run around of designation will ensue.”

“The pressure on providers, authorities, regulators and people who are being discharged from hospital will be huge.”

The DHSC letter said it is hoped that every local authority will have access to at least one CQC designated site by the end of October.

The cost of these designated facilities is expected to be funded through the £588 million discharge funding.

The letter, from the DHSC’s director for Adult Social Care Quality, Tom Surrey, reads: “Emphasis should be on commissioning standalone units or settings with separate zoned accommodation and staffing.”

The designated scheme does not apply to residents who contract Covid-19 in their care home, people using emergency departments who are not admitted, or people supported to live in their own home, it adds.

First and foremost, it should certainly not be the case that homes are forced to accept Covid-19 hospital discharges, as may have happened last time

Local authorities have also been asked to ensure there is repeat testing, sufficient personal protective equipment (PPE), arrangements for staff isolation or non-movement, protection from viral overload, sickness pay and clinical treatment.

Mike Padgham, chairman of the Independent Care Group (ICG), said he would like to see the Government show more leadership so councils and providers are not left to “shoulder all the pressure on their own”.

He said: “First and foremost, it should certainly not be the case that homes are forced to accept Covid-19 hospital discharges, as may have happened last time.

“They should not be put in such a position that they are forced to accept Covid-19 discharges as a means of survival.

“The Government must provide financial support to homes so that survival and filling empty beds is not the sole reason homes decide to accept discharges. It has to be an issue that each home can decide upon, based on their own circumstances.”

Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said it is “absolutely essential that lessons are learnt from the first wave, to avoid a repeat of what happened previously”.

He continued: “Care providers remain under intense strain. For many, those experiences are now compounded by problems with the testing regime and uncertainties around funding, along with caution about taking on anything new or with greater risk.

“Councils and care providers will work closely together to identify the most appropriate care homes, with the priority being that any measures must be designed to keep everybody, including both those who work in and receive care services, safe and to avoid the spread of infection.”