Trusts to subcontract care homes in bid to fix covid discharge problems

HSJ revealed in November that many parts of England had insufficient care homes designated as being able to take patients discharged who have tested positive – in large part because providers who were willing to take on this role said they could not get indemnity from their insurers.

NHS England has been trying to find a solution since before Christmas and on Wednesday published details of a new national scheme, along with other moves to try to speed up discharge from hospital of covid and non-covid patients.

The letter from NHSE director of community health Matthew Winn says: “The Department of Health and Social Care will provide time-limited indemnity cover to the small number of designated care home facilities that need this support.”

However, the move will not be achieved by a Treasury policy change, as had been considered, but by a workaround whereby the care homes will be subcontracted by the NHS trusts, so that they can be covered by the NHS clinical negligence indemnity scheme.

The letter says: “The scheme is administered by NHS Resolution on behalf of [the Department of Health and Social Care] and requires NHS trusts to put in place sub-contracting arrangements with the care home on behalf of the local system…

“The trust will transfer the person to the care of the operator of the designated setting, as a continuation of the commissioned pathway, sub-contracted to the care home operator… The NHS trust is thereby given and retains overarching clinical and care responsibility for the person/patient.

“The transfer to the designated setting is therefore a change in where the care is provided as the pathway continues rather than a discharge and start of a new pathway.”

NHSE’s letter says this care can be paid for from an existing £588m hospital discharge fund announced by government in the autumn which runs to 31 March 2021.

It says this money can also be used to pay for two other schemes, which are being encouraged to speed discharges:

1. “Use of hotel accommodation as a short term measure… where there are delays in arranging care home support”
2. Buying independent sector “hospital at home” care and reablement/rehab services to increase capacity in the care sector.