The Department of Health hopes that the Community Care (Delayed Discharges etc) Bill will create incentives for local authorities to ensure care packages are in place when people are due to leave hospital. The aim is to improve partnerships between local authorities and health services to provide 'seamless care'.

The Bill makes provision for the NHS to impose a fine on local authorities in cases where the discharge of a patient from hospital is delayed because community care services are not in place. Age Concern welcomes the availability of certain free community care equipment, which the Bill provides. We are worried that the Bill could lead to older people being sent home from hospital too quickly or being forced to accept inappropriate placements.

Lack of consent

The rights of the patient are conspicuously missing from the Bill. There is no mention of the need for the patient to consent to discharge arrangements, or for their carer to have their needs assessed.

The Bill gives no assurance that patients will have adequate information to make a decision about where they go or that the will be consulted on the options.

No provision is made for advocacy to be provided for patients who cannot represent themselves and the Bill is silent on what should happen if a patient disputes the arrangements that have been made on their behalf.

Contradictions

Age Concern believes that the failure to give patients a say in their discharge contravene Standard 2 of the National Service Framework for Older People which states that 'NHS and social care services treat older people as individuals and enable them to make choices about their own care'.

The Bill also contradicts the conclusion of the Health Select Committee's inquiry into delayed discharges which said 'it is essential that patients should as much as possible be partners in the discharge process'.

Premature discharge

We are very worried that putting financial penalty on delayed discharge will encourage premature discharge.

Older people may need longer to recover from an operation or illness but the new arrangements may mean not enough emphasis is placed on the effects early discharge may have on an older person's health or that of their carer.

Inappropriate placements

Pressures to get people out of hospital may lead to inappropriate care arrangements being made. Local authorities facing penalties may offer the quickest solution of residential care, rather than taking time to set up a complex package of care at home.

If the patient's chosen care home does not have a vacancy immediately, there may be pressure to move into another, less suitable care home. We are worried that if an inappropriate placement has been made, the older person may be dropped from the waiting list for their home of choice or feel they can't face the disruption of another move. This may lead to patients settling for second best.

Joint working

The Government's policies have led to better joint working between the NHS and local authorities. We are worried that the Bill may undermine this good work by fostering a 'blame culture'.

Ending charges

Part Two of the Bill ends charges for equipment and intermediate care. We welcome this, provided that the list of equipment that is given free is sufficiently broad. The Explanatory Notes to the Bill note a few items 'ranging from walking sticks to grab rails' .Mobility aids can often make the difference between an older person making a speedy recovery and being readmitted to hospital.

Intermediate care

Current guidance allows for intermediate care for those coming out of hospital to be given free normally for six weeks. The Bill introduces a strict time limit of six weeks.

We would like reassurances from the Government that those needing a longer period of rehabilitation will receive it free.

Age Concern hopes that Government will modify its plans for fines for delayed discharge.

If not, we believe it is vital that implementation of the scheme is delayed unti12004 so the proposals can be piloted to assess what impact they have on older people's rights and the services they receive.

Minimum Income Guarantee (MIG)

First Steps: Contact your local 'Age Concern' - tell them your particular problem e.g. disablement or difficulty in coping with your needs as a pensioner and that you need help to complete Welfare Benefit forms. They will bring the forms along when they visit.

You will probably get a letter back, informing you of a waiting time, possibly about 5 weeks, before you get a date for the visit. It's always wise to start to contact them by telephone just before the 5 weeks are up -to try to get a date for your visit. Eventually you will get an appointment for this visit at your own home.

Make sure you have all details of any savings, bank or building society and your pension, including any occupational pension you may be receiving. If you receive' Attendance Allowance' this does not count as income.

Age Concern will then help you to complete the forms; they will also want copies of all your income, to send off with the completed forms. These (pension books etc) will be returned to you the next day. Make sure you get a signed receipt for these before parting with them.

They will then send the forms off to the Glasgow Pension Centre, 'the Pension Service' and eventually you will get a reply to say whether they agree-with Age Concern's calculations, and how much you should be receiving each week. They will 'back date' to when they first received the forms from Age Concern.

This could take some time, but it is worth the effort, because if you are entitled to Income Support which could be for example,( 60pence per week) you are entitled to free dental and eye treatment. If you are renting a Council House, the rent is paid and Council Tax.

If you own your property, Council Tax will be paid. Other benefits are payable such as Cold weather allowance, fares to and from Hospital.

For example, if the MIG works out 80 pence, your Council Tax is £18 per week, the support is worth £18.80 a week to you.

There must be hundreds of pensioners struggling on their meagre incomes who should be receiving this help, so if you think you may qualify, it is up to you to 'give it a go'.