Intended for healthcare professionals


Choice and responsiveness for older people in the “patient centred” NHS

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:4
  1. David R Rowland, research fellow,
  2. Allyson M Pollock, professor (
  1. Public Health Policy Unit, School of Public Policy, University College London, London WC1H 9QU

    New community care regulations mean that older people may not be able to choose where they are treated

    According to the health secretary, John Reid, a patient centred NHS driven by the principles of choice and competition will improve equitable access to health care in particular for the poor and disadvantaged. The patient, and not the provider, will be king while NHS provision will still be provided on the basis of equal treatment for equal need. But it is difficult to reconcile this vision of choice and equity with the Community Care (Delayed Discharge) Act, which comes into force in January 2004.

    From January 2004 local authorities will be fined by the NHS for failing to arrange social care services for patients who are no longer appropriately situated in an acute hospital bed. Under the provisions of the Community Care Act social service departments will have a minimum of two days to assess the needs of a patient and arrange a suitable package of care—whether this be at home or in other forms of accommodation—or face a fine of £100 ($177; €142) for every day the patient remains in hospital. If on Monday at 2 pm an acute trust issues a notification to local …

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