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Reimbursement in practice: the last piece of the jigsaw?


The study sought to explore the impact of reimbursement and alternative hospital admission/delay reduction strategies on the broader context of partnership working between health and social care and on older people and their family members/carers involved in this process. 

Research team

Gill Hubbard, University of Stirling (Principal Investigator)
Edward Donaghy, University of Stirling
Jill Manthorpe, SCWRU
Michelle Cornes, SCWRU
Mary Godfrey, University of Leeds
Jean Townsend, University of Leeds
Alison Petch, Glasgow University
Phillip Rapaport, User Researcher


Department of Health: National Service Framework for Older People Research Initiative


Delayed discharge from hospital for older people has been identified as a problem for the welfare state since its inception and has prompted a range of policy and service development responses. Most recently, in England a reimbursement scheme has been introduced, echoing the apparent success of a similar initiative in Sweden in reducing delayed discharges.


The study was comparative; located in England where reimbursement has been implemented and in Scotland where it has not. The research was carried out in five local authority areas (three in England and two in Scotland) and comprised three stages:

  • Examining patterns of delayed discharge and reimbursement through available statistical data.
  • Exploring ways in which the introduction of reimbursement impacted on delayed discharge and on initiatives associated with delayed discharge, including partnership working and strategies for intermediate care. 50 in-depth interviews were carried out with key informants at strategic and operational levels.
  • Assessment of the impact of delayed discharge and reimbursement in England and different policies to tackle the problem in Scotland on service users and carers. The final stage of the study ran in parallel with stage two and explored the experience of the ‘patient journey’ from the perspective of 75 service users and their informal carers, comparing the potential impact of the policy of reimbursement in England with the parallel experience in Scotland.


April 2003 – June 2007


Godfrey, M., Townsend, J., Cornes, M., Donaghy, E., Hubbard, G. & Manthorpe, J., (2008), 'Reimbursement in Practice: The Last Piece of the Jigsaw? A comparative study of delayed hospital discharge in England and Scotland' [pdf, 752 KB], Stirling, Leeds and London: University of Stirling, University of Leeds, King's College London.
Cornes, M., Manthorpe, J., Donaghy, E., Godfrey, M., Hubbard, G. & Townsend, J., (2008), 'Delayed discharge from hospital: supporting older people to exercise choice', Working with Older People, 12(1): 16-20.
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