Whole-system commissioning during the pandemic

Ewan King and Naheed Chaudhry look at how discharge to assess has placed strain on relationships between councils and hospitals during COVID-19 – and at how to rebuild a health partnership with the NHS.

It is increasingly accepted that, while the pandemic caused huge damage to local public services, it did succeed in building a closer relationship between the NHS and local government. Moreover, the Government has now taken steps to further formalise the partnerships, through its White Paper Integration and innovation: working together to improve health and social care for all, which places integrated care partnerships on a statutory footing.

This is good news, but the relationship is not without its challenges, and one policy in particular – Discharge to Assess – has been very difficult for many local authorities. An evidence base for the longer-term impact of COVID on adult social care from one London borough shows half of residents discharged into a care home following a COVID-19 hospitalisation remained in the placement beyond six weeks. Sixteen per cent of those receiving domiciliary care in their own homes also continued to demonstrate need beyond six weeks.

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