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Analysis reveals scale of DTOC funding threat

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Half of the councils that did not meet their September target for reducing delayed transfers of care have recorded a deterioration in performance since February, raising the possibility they could have funding taken away, new research has shown.

Analysis by Impower of delayed transfers performance figures for September, published by NHS England last week, reveals that 106 councils of 150 councils (70%) failed to meet their target to reduce the number of delayed transfers attributable to social care (see map).

Of the 106, performance by 53 councils has worsened since February, the baseline month used to set government expectations.

The analysis shows that in 29 of these councils total DTOCs across social care and NHS were already below the national target of 9.4 delayed days per 100,000 of the population in February.

Impower’s lead health director Sarah Atkinson told LGC there was “real concern” for the remaining 24 councils as they were operating at above the 9.4 target in February and delayed transfers have risen still further.

She added these councils were currently vulnerable to having funding withdrawn, as outlined in the Better Care Fund planning guidance published in July, and could be targeted for whole system inspections by the Care Quality Commision.

Ms Atkinson said it had taken time to get the improved Better Care Fund, including the £1.1bn allocated this year from the extra £2bn announced in the budget, into the system, but the impact was now beginning the be felt.

She said local relationships between organisations and system-wide working are key to success but added that in 50 of the 150 councils analysed, delayed transfers attributed to social care were decreasing while delayed transfers attributed to the NHS were increasing - and vice-versa.

Ms Atkinson said: “This is surprising when they are trying to get people out of the same place and suggests they are not working on this together.

“There is still a bit of finger pointing going on and some debate on whose responsibility it is to get specific patients out of hospital. More than that, there is a whole range of different organisations trying to do a whole range of different things. There are lots of projects and there is an issue about co-ordinating that and understanding what the impact of that might be on patients and delayed transfers.”

She added that she had been “greatly concerned” by some patients being placed in care homes due to the pressure to transfer them out of hospital when an assesment in their own home would have been more appropriate. 

Ms Atkinson added: ”By putting someone in their own home you see a different level of ability for them to cope and then the assessment becomes quite different and at lower need.”

The Care Quality Commission’s chief inspector of social care has warned that a focus on short-term targets for reducing delayed transfers of care from hospital could put elderly people at risk.

A total of 18 councils were initially placed in a BCF escalation process last month over their plans for reducing delayed transfers of care.

One of these, Staffordshire CC, announced today that it had agreed a new plan with NHS England.

Calderdale MBC’s cabinet member for adults, health and social care, Bob Metcalfe (Lab) told LGC the councils was also placed in the process, but has since agreed a new target with NHS England.


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