The NHS and Community Care Act 1990 requires social services departments to assess elderly inpatients who may need help after discharge from hospital and to use a care management process to arrange their care.1 One of the main aims of the act was to reverse the “perverse incentive” for people to be cared for in private residential and nursing homes. The act tried to achieve this aim by ensuring that money that was originally available through social security to people in private homes who received income support was transferred to social services departments; social services could use the money to maintain people in their own homes.

Concern was expressed that the new assessment and care management might delay patients' discharge from hospital,2 and such delays have been reported.3 It was also thought that a surge in the number of patients discharged to private institutions might occur before the act came into force as consultants tried to avoid becoming entangled in the new administrative procedures.

This study compared the proportions of patients discharged to private residential and nursing homes or elsewhere form a department of geriatric medicine before and after the implementation of the NHS and community care act in April 1993 and the lengths of time patients had spent in hospital before their discharge.