Supporting hospital discharge: Designated settings

There are lots of bright ideas floating around at the moment about what social care can do to help ease pressures in NHS services. I’m going to talk through a few of them, because they are being made to seem much more straightforward than they actually are. Let’s begin with designated settings.

When I talked through the salient points of the government’s coronavirus guidance here, I mentioned designated settings and how uncomfortable I am with them as a concept. I am afraid I have not entirely managed to shift that unease. I absolutely understand the need for somewhere for these individuals to be cared for safely, but just like with so many things related to social care, its not quite as simple as you might think after reading the guidance.

How does an authority even go about setting up a ‘designated setting’, after all? It is clear that CQC has a streamlined procedure for registration, but there is an awful lot that needs done before that stage.

A provider needs to be found, and that requires a proper procurement process commensurate with the value of the contract. My understanding of that element is limited, but it’s fair to say that is rarely straightforward.

What I do know a lot more about, is what comes after that. A building needs to be found, adapted and made safe in accordance with CQC standards. I very much doubt many areas have an abundance of empty but ‘ready to go’ properties just lying around. Any empty properties are likely to be boarded up and depending on how long they’ve been empty for, are likely to need more than just a ‘lick of paint’.

Suitable equipment needs to be sourced as well. Kitchens need equipped, rooms need furnished, laundry facilities need installed.

These places need staffed too. And whilst I did read a very lovely news story the other day about retail and hospitality workers becoming carers during the pandemic, the idea that there are significant numbers of trained care workers sitting around waiting for a job seems somewhat far fetched to me. Sickness absence is high in the care sector, unsurprisingly, and bank lists are exhausted in many places.

Let’s not forget, care homes are staffed by a range of people from cooks and cleaners through to carers of a range of levels of experience and qualifications through to registered managers. The idea that anyone who is available could undertake all of these roles is actually quite insulting to many in the care profession. Not to mention being a safeguarding alert waiting to happen.

And let’s also remember that individuals moving in to these settings may have a range of needs and abilities so specialist expertise is likely to be needed as well.

Then there are issues with insurance as well, with many insurance providers declining cover to such settings to the point that additional government backed temporary schemes are being set up.

After all, whilst the Coronavirus Act 2020 enables local authorities to relax their Care Act duties, at the time I am writing this, no local authority is operating under those easements. That means that every local authority in England and Wales (sorry Scotland and Northern Ireland, you are beyond my expertise) has to make sure that all eligible care needs a met. So if local authorities are making these placements, even just for the short term, they need to be satisfied that needs will be met. And needs are a lot more individual than just needing ‘any residential placement’.

All of this gets even more complicated if the local authority plans to repurpose an existing placement. This is most assuredly NOT something I, or any local authority lawyer, will likely recommend. But if there aren’t any suitable empty properties available, it is something many authorities will be pushed to consider.

There are a whole host of additional issues if that is what is proposed. Moving individuals from a care home is a complicated business. The local authority will be under a duty to make sure needs are still met in any alternative placement. That might be easy for some people, but for many, especially if they have been settled for a long time, a move may not be able to meet needs. There may be particular needs that a new environment and new staff team simply won’t be able to provide for. This is particularly concerning for people with dementia, for example, for whom a change in environment may prompt a significant determination in the condition. Many people with autism may be adversely affected by a change in their routine. Any number of things could come up meaning that the local authority would be in breach of its Care Act duties if it moved people out of a care home.

Not to mention that this isn’t something that can be done at the drop of a hat. Even after individual assessments have taken place and suitable alternative accommodation identified, residents in care homes occupy the placement under a licence. Even on termination of a contract to fund the placement, which itself will have notice periods and requirements, notice also needs to be given to terminate that licence. That should be no less than 28 days notice.

Once that notice has expired, residents cannot simply be packed up and moved on. If the person chooses not to leave an order for possession will need to be sought through the court. Under the Coronavirus Act 2020 that can take 6 months plus.

I’ll not go into the ins and out of that, because Ben McCormack already has, and he’s smarter than me. Just remember that his article was written before the Coronavirus Act 2020 extended time frames.

So if your authority hasn’t got designated settings up and running yet some of this might be why!

In case it isn’t obvious from the fact I still haven’t identified the authority I work for, the views expressed on this blog are my own opinion and not the opinion of that local authority