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DTOC targets could hit a nerve on the backbenches

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LGC commentary on delayed transfer of care targets

Staffordshire CC’s deputy leader Alan White (Con) could barely contain his frustration during a cabinet meeting this morning as he updated colleagues on social care funding in the context of targets imposed on councils to reduce delayed transfers of care.

He said Staffordshire had been placed in a Better Care Fund “escalation” process after being one of the 32 councils that had recently received a letter threatening to withdraw funding next year over perceived poor performance. The letter was jointly signed by health secretary Jeremy Hunt and communities secretary Sajid Javid.

LGC has learned that 18 of those 32 councils, including Staffordshire, were immediately placed in escalation. This requires councils and local health organisations to agree new plans at meetings involving officials from the Department of Health, the Department for Communities & Local Government and NHS England with a just matter of weeks to go until the November deadline by which they must demonstrate improvement - or face the prospect of losing vital funding next year. LGC understands a small proportion of the 18 have already agreed new plans, with the rest still facing an uncertain future.

Cllr White said a plan submitted on 11 September – a month after the BCF planning guidance was published - was approved by regional and national NHS England assurance panels but subsequently rejected by “an individual” in NHS England “who thinks we can do it better”.  LGC has been told a number of other councils that have been warned over their DTOC reduction plans had also previously agreed them through the same process.

Cllr White defiantly added that Staffordshire and its NHS partners would present “a united front” at a scheduled meeting with DH, DCLG and NHS England officials in London tomorrow and defend existing “credible” plans that would reduce delayed transfers in a “realistic timescale”.

But he admitted a failure to resolve “points of difference” could have “serious consequences” for Staffordshire’s finances and wider service delivery. Starkly, he warned that if “logic and common sense” does not prevail, some “very difficult decisions” would have to be made “corporately and within social care” to ensure the council is financially sustainable.

LGC has been told that Mr Stevens’ apparent willingness to override the established BCF assurance process is perceived by councils as indicative of his ongoing determination that the lion’s share of the extra social care funding announced in the budget should be directed at relieving pressure on the NHS.

Likewise, Mr Hunt’s position, despite Local Government Association chair Lord Porter insisting that the health secretary has ditched plans to withdraw funding from councils this year, is perceived as reflecting a fragile government’s desire to avoid the political damage caused by uncomfortable coverage of an NHS winter crisis, rather than see the bigger picture of potential damage to a struggling social care system and wider public services.

In an interview with LGC the Care Quality Commission’s chief inspector for social care Andrea Sutcliffe implored councils to “continue to do was it is right” when faced with DTOC targets and said she feared pressure to move people through hospital quicker could put vulnerable patients at risk.

While negative press on the NHS struggling to cope with demand would be damaging, the government could also grow nervous of harm to the elderly being attributed to the policy.

LGC understands that Tory dominated county councils have begun to alert local MPs to the potentially dire consequences for services in their constituencies if the government’s approach continues. If a significant number are willing to shout loud enough, this could cause growing unease over the policy in an already divided cabinet.

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