Government guidance clarifies the ‘duties to cooperate’ when discharging patients from inpatient mental health settings

New Department of Health and Social Care and NHS England guidance has been published on how NHS bodies and local authorities should work in collaboration with each other to support the discharge of children, young people, and adults from mental health, learning disability, and autism inpatient settings and to make sure that the right support is being provided in the community. 

The guidance clearly sets out the key principles under which NHS bodies (including NHS trusts, NHS foundation trusts, and integrated care boards) and local authorities should work together for effective discharge.

While the statutory duty to have regard to this guidance applies to NHS bodies and local authorities and not the independent sector, commissioners of inpatient services should ensure that all mental health inpatient providers are aware of this guidance, including those in the independent sector. Commissioners will be expected to have regard to this guidance when commissioning services from the independent sector.

Eight principles for effective discharge

1. The individual’s autonomy and power to choose must be respected throughout the process and all discharge decisions must be informed by their choices with the individual at the centre of their own discharge planning.
2. Carers (including family members and young carers) should be involved in the process as soon as possible, and preferably from before the point of admission, and should be offered the relevant support.
3. Discharge should start being planned as early as possible and should be an ongoing process while the individual is in hospital with reviews of the plan happening regularly.
4. When the individual is Clinically Ready for Discharge (CRFD), the health and social care professionals should work closely together with the multidisciplinary team to ensure that the individual is discharged in a safe and timely manner, to the appropriate place and with the necessary package of care in place.
5. When planning discharge, include the professionals who will be involved in providing the right care and support to the individual post-discharge to help prepare them for the transition back into the community.
6. Protocols should be in place to ensure the secure and timely sharing of information between NHS bodies and local authorities.
7. Senior strategic oversight should be in place to reduce unnecessary delays, develop solutions to discharge people who are CRFD, and establish protocols to provide clarity on each organisation’s role and responsibility throughout the discharge process.
8. Funding mechanisms should be agreed by all partners in a timely manner and be aligned with duties under the Care Act 2014, Mental Health Act 1983, Children Act 1989, Children Act 2004 and the Children and Families Act 2014.

Key points to note

The emphasis within the guidance is on ensuring that the individual and their chosen carers are at the centre of discharge planning and are supported to remain actively involved throughout the whole process. Other relevant professionals should be involved, including those who will be involved in the individual’s care post-discharge. Planning for discharge should start from admission, if not before, and should be reviewed at intervals with the discharge itself being carried out in a timely manner.

Those at risk of delayed discharge should be identified and escalated following local protocols. Children at risk of becoming ‘looked-after children’ should be similarly identified and the local authority closely involved in their discharge planning.

The emphasis in the guidance is on collaboration and involving the right people and organisations at the right time. NHS bodies and local authorities are encouraged to work closely and transparently together with the individual, their chosen carers, and professionals who are or will be involved in the individual’s short-term and long-term care and support.

Particular attention should also be paid to Annex B – on the non-statutory guidance about budgets and responsibilities for section 117.

It is also especially important to remember that NHS bodies and local authorities have a statutory duty to have regard to this guidance.

You can read the full guidance, including annexes on mental capacity considerations and section 117 aftercare, here.

If you would like to discuss any of the issues raised here or require support with discharge planning from a mental health, learning disability, or autism inpatient setting, please contact a member of our expert health and care team.