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Forget threatening DTOC targets, extra funding is driving improvements

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Commentary on the latest delayed transfer of care figures

The analysis of delayed transfers of care attributable to social care in November by Impower shows local government is moving in the right direction despite relentless demand pressures and, in some cases, with limited support from the wider health system.

When the targets for reducing delayed transfers were initially set last July they were done so using a baseline of performance in the previous February.

This target now forms part of a series of five metrics that will be used by the Department of Health & Social Care this month to judge whether to take control of a third of a council’s improved better care fund allocation in 2018-19, instruct a Care Quality Commission system-based review, or perhaps both.

The February baseline, which had been criticised as relying too heavily on a narrow, and perhaps atypical, period of time, still forms part of two of the five metrics.

It is with considerable credit to councils, providers and care staff that overall performance has improved by 22% since then, with a huge 9% improvement in November. This is about twice the level achieved by the NHS.

Rather than being down to the heavy-handed and short-sighted threat of punitive targets, which in some areas have further disrupted relationships between the NHS and local government, the progress made is more likely to show that the additional social care funding announced in last year’s spring Budget is beginning to have an impact.

It is no surprise that local government, well-versed in making the most out of not much, appears to have levered significant improvement from the extra cash.

Despite this progress the November figures show the government’s target of reducing overall delayed bed days per 100,000 of the population to 9.4 remains a long way off.

The target appears unrealistic – some would say impossible – with the current level of funding and capacity.

The fact that such a significant number of areas are operating above target, with a significant number getting worse, demonstrates the daunting scale of the challenge ahead.

This is compounded by an ongoing winter crisis, with high levels of hospital admissions inevitably increasing pressure on the hospital back door and driving demand for transfers with care packages.

A county chief executive recently told LGC having conditions imposed on some social care spending would be preferable to a CQC area-based review, which could uncover “all sorts of problems”.

But the reviews do provide an opportunity to get a firm grasp on the drivers of poor performance – and offer the possibility of ways to break the cycle of struggle.

The best performing areas have not only developed strong relationships across the whole system, but are managing to invest in measures to prevent people from entering hospital.

Most importantly this is better for older people but, ultimately, it’s the only way to manage demand and costs across health and care systems.

But the timing of the green paper, which has banished any serious social care reform to the next parliament, means further investment will be required in the short term to ensure good practice is maintained and struggling areas can begin to improve.

Jon Bunn, senior reporter

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