My Lords, I thank all noble Lords for their contributions to this debate. We are looking to move towards a more integrated care system for precisely some of the reasons that noble Lords have laid out: that a patient is discharged by a hospital but it is not done in an integrated way. As the noble Baroness, Lady Wheeler, said, during the pandemic local authorities and the NHS developed innovative ways to support better discharge from hospital to community care, and what we want to see is discharge to assess as one model. In some cases, it might be the best model: for example, where people are over the age of 80, the longer they stay in hospital, the more you see muscular deterioration. That is one of the reasons given for why, in some cases, discharge to assess might be the most appropriate.
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What we are proposing does not change existing legal obligations on NHS bodies to meet their local population’s health needs, and local authorities are still required to assess and meet people’s needs for adult social care. We want to see, under the ICS system, that it is done in an integrated way and that somebody does not fob off a patient or treat them as an object just to get them out the door. In addition to these responsibilities, we are co-producing draft discharge guidance setting out how the existing statutory duty in the National Health Service Act 2006, which requires health and social care partners to cooperate, will apply to discharge. This will be statutory guidance, subject to parliamentary passage of the Bill, using the new guidance-making power introduced by Clause 66. Such guidance will make it clear that people should not fall through the gaps but should receive the right care at the right time in the right place. Everyone who requires a social care needs assessment should receive one in a timely manner, and, where appropriate, health and social care staff should involve family and other carers in the discharge-planning process.
This draft guidance on co-operation that I mentioned is being co-produced with Carers UK and the Carers Trust. We will promote carers’ rights throughout that guidance, including setting a clear expectation that carers should be routinely consulted throughout the discharge-planning process, including establishing whether carers are able or unable to provide care. The evidence is clear that, in some cases, when patients are clinically ready, the most effective route for their long-term outcome is to discharge them as soon as possible—but not always, as many noble Lords have said. We also understand the need for accountability, and that is why NHS England will now publish hospital discharge data.
I share the concerns of many noble Lords about unpaid carers, and celebrate the work they do and the vital contribution that they make to the lives of those for whom they care. There are processes in place by which unpaid carers are identified and can identify themselves. For example, there are ways for health workers
to record within the unpaid carer’s health records that they are an unpaid carer. Unfortunately, self-identification as a carer is not always straightforward, and that identification should be done with the carer’s consent. What we want to see from the Bill is a duty on the ICBs and NHS England to make sure that the arrangements for patients are done in a joined-up way.
We also know that know that local authorities are already under existing duties to assess and meet carers’ needs for support. We are concerned that duplicating these duties by placing them on the NHS in addition to local authorities might not offer a clear benefit to carers, and this should be done at the ICB level. The draft hospital discharge guidance that I mentioned is clear that people should be discharged on to the right pathway, not only on the discharge to assess model but whatever is the most appropriate model.