Hospital Discharge and HBCCC for Dementia in Scotland

Your parent with dementia has been admitted to hospital after a fall, an infection, or a sudden decline. Now the discharge team is pushing to move them out. The pressure feels relentless, and you are not sure where your parent should go or who pays for what.

The hospital discharge process for someone with dementia in Scotland has its own rules — and one critical distinction from the rest of the UK.

Scotland Does Not Have NHS Continuing Healthcare

If you have been researching online, you may have found information about NHS Continuing Healthcare (CHC) — a framework where the NHS funds all care costs if a patient's primary need is healthcare rather than social care. That system exists in England and Wales, but Scotland abolished it in 2015 and replaced it with Hospital Based Complex Clinical Care (HBCCC).

This matters because the eligibility criteria and funding model are completely different.

What Is HBCCC?

Hospital Based Complex Clinical Care is designed for patients whose clinical needs are so complex that they can only be safely managed in a hospital setting — not in a care home or at home with support.

The eligibility assessment uses a single nationally mandated question: "Can this individual's care needs be properly met in any setting other than a hospital?"

If the multidisciplinary team concludes that no other setting can safely manage your parent's psychiatric and medical needs, they qualify for HBCCC. Under HBCCC, the NHS funds 100% of the patient's care and accommodation costs.

If the team concludes that your parent's needs can be met in a community care home, they are discharged. The NHS continues to fund clinical medical needs, but accommodation and personal care costs become subject to the local authority's social care funding rules.

The 90-Day Assessment Rule

All patients who remain in hospital for 90 days must be formally evaluated for HBCCC eligibility. The assessment is carried out by a multidisciplinary team using the Summary Assessment Tool (SAT) and includes input from GPs, consultant psychiatrists, and social workers.

In practice, most people with dementia who are discharged to a care home do not meet HBCCC criteria, because their needs — while significant — can be managed in a specialist dementia care home rather than a hospital ward.

Section 13ZA: Emergency Placement Without Guardianship

If your parent lacks capacity to consent to a care home placement, does not have a Welfare Power of Attorney or Guardian, and does not actively object to the move, the council can use Section 13ZA of the Social Work (Scotland) Act 1968 to arrange the placement.

Section 13ZA is a practical tool for avoiding delayed discharges, but it has strict limits. It cannot be used if the placement involves a locked unit or restrictions that amount to a deprivation of liberty under Article 5 of the European Convention on Human Rights. In those cases, the council must apply for a Guardianship Order through the Sheriff Court.

Challenging a Discharge Decision

If you believe your parent is being discharged too early, or that their HBCCC eligibility has been wrongly assessed, you can:

1. Request a formal reassessment
2. Register a complaint using the hospital's Appeals Process Proforma
3. Seek free advocacy from the Patient Advice and Support Service (PASS) at 0800 917 2127
4. Escalate to the Scottish Public Services Ombudsman (SPSO) if local resolution fails

Do not sign any paperwork agreeing to a discharge plan you believe is unsafe. You cannot be forced to take your parent home if the placement is not clinically appropriate.

Our Scotland Dementia Care Guide includes a hospital discharge rights checklist and template letters for challenging unsafe discharge decisions.

See more Scotland guides →