South Ayrshire Council is set to award a £820,000 contract to the British Red Cross without open competition as part of a new drive to get medically fit patients out of hospital sooner.
The council’s Cabinet is being asked to approve a one-year “Discharge to Assess” trial, which would allow patients to return home with intensive short-term support while their longer-term care requirements are assessed. This aims to free up hospital beds where patients who are deemed fit enough to leave hospital are unable to because of a lack of a suitable care package.
Approach already used elsewhere in Scotland
The approach is already being used elsewhere in Scotland and has been identified by the Scottish Government as among the best-practice measures it wants local areas to adopt to tackle delayed discharge. Ministers have previously highlighted a British Red Cross-run Discharge to Assess service in Fife as an example of partnership working which can reduce pressure on acute hospitals.
Similar approaches have been developed elsewhere, although different areas have taken different routes to commissioning and delivering the service. In Aberdeen, the city’s Health and Social Care Partnership went to the market last year for a provider to establish a dedicated Discharge to Assess team. That service supports people who are medically fit to leave hospital but whose needs might otherwise indicate they require a care home placement, giving them a period of recovery and assessment in their own home instead.
Before going out to tender, Aberdeen published a notice specifically testing whether providers were capable of delivering the service. It said a competition would follow if more than one suitable provider expressed an interest. The subsequent contract, covering an initial two-year test with the possibility of a further three years, was awarded at a total value of around £7m.
Falkirk has also been using Discharge to Assess as part of efforts to move people out of hospital and provide care closer to home. Its model assesses people at home or in community facilities for up to 21 days before decisions are made about any ongoing care package they require. Falkirk HSCP said the approach was being used to support the discharge and transfer of an additional 32 people from Forth Valley Royal Hospital.
Direct award without open competition
In South Ayrshire, however, officials want to award the initial contract directly to the British Red Cross rather than run an open procurement exercise. They say exceptional circumstances justify the decision, including the need to use time-limited external funding and have the service operating before anticipated winter pressures. The council report also states there is an “absence of an alternative provider capable of delivering a comparable service within the required timescales”.
The £820,000 service would provide intensive, short-term support to South Ayrshire residents who are medically fit for discharge and being considered for longer-term care. Instead of remaining in hospital while their needs are assessed, patients would return home for a period of assessment, rehabilitation and support.
While it has seen improvements, South Ayrshire has historically had the highest number of delayed discharges across the three Ayrshire authorities. South Ayrshire Health and Social Care Partnership says demand continues to exceed capacity in parts of the health and care system despite investment in intermediate care and community services. Officials say assessing people at home can help them retain greater independence while reducing hospital delays and avoiding unnecessary admissions to long-term residential care.
Funding and next steps
If approved, the service would be expected to begin on November 3, with its performance measured against delayed discharge, hospital length of stay and whether subsequent care arrangements are sustainable. The entire £820,000 cost will be met through additional resources allocated by NHS Ayrshire and Arran, which would ultimately benefit from the drop in delayed discharges.
The health board has confirmed funding for a Discharge to Assess model is recurring, although that does not guarantee the British Red Cross would continue to provide it after the trial. If the test proves successful, the partnership says a full competitive procurement exercise would be undertaken before the one-year contract expires.
Officials warn that rejecting the proposal would mean returning the funding to NHS Ayrshire and Arran. They also say the number and length of stays involving South Ayrshire residents who are medically fit for discharge but remain in acute hospitals would be likely to remain high, potentially bringing further Scottish Government scrutiny. Cabinet will be asked to approve both the £820,000 contract and the decision to award it without prior advertisement or competition when it meets on August 26.
