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Colin Noble: Counties' DTOC targets are grossly unfair – we need better solutions

Colin Noble
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It is too simplistic to lay the blame for delayed discharges from care solely at the door of social care services.

Less than one third of delayed discharges in county areas in 2016-17 were attributed to social care only but pressure applied by the health sector has culminated in ministers recently publishing guidance that suggested badly-needed funds could be withdrawn.

The issues that give rise to delayed discharges are complex. Grossly unfair local authority reduction targets – 43% on average for counties – do not recognise this.

The £2bn social care announcement in March was a much-needed short-term boost but failure to meet discharge targets, which in some places will be nigh-on impossible, could result in some of this badly-needed money being taken off some of the most underfunded councils in the country.

More, not less, funding is clearly part of the answer. The forthcoming green paper on social care funding presents an opportunity to consult with the sector on practical options. We must look far and wide at funding models, such as those in Japan and Germany, and fully explore the cost implications of a cap on care.

People should not face catastrophic bills as the result of conditions that are out of their control. The government should make it clearer what financial burden people could face further down the line, what state support could be available and ways of planning for this early on.

But of equal importance to a sustainable model is the fairness of any funding. One of the main reasons delayed transfer rates are higher in counties than elsewhere is they receive significantly fewer resources and have seen the largest cuts in cash funding whilst demand has grown.

These independently verified facts are not recognised in the way councils are funded and therefore wider reforms to local government finance must be considered.

Money will only go so far though; a more joined up approach with local health partners, and within local government itself, is necessary.

Shifting the focus from hospital to community care will involve significant upfront investment and new ways of working. Considerable sums of public money are being used to constantly firefight delayed discharges that we could refocus within the system.

County Councils Network analysis estimates the cost to the NHS of delayed discharge days last year stood at £320m.

If there was more care home capacity and more care packages available, it could save up to £242m a year, with that money being channelled into preventative and community care instead.

We should look to develop a system whereby the focus is on preventing people going to hospital in the first place. We hope the green paper explores this but it also must look to challenge existing practice and culture. One example would be to consider whether the way we administer disabled facilities grants requires reform. People in county council areas experience nearly double the delays in leaving hospital compared to the national average because they are awaiting the installation of equipment and adaptions.

It’s these types of solution-based proposals that counties will need to debate with government when the long-awaited consultation is launched.

Colin Noble (Con), health and social care spokesman, County Councils Network and leader, Suffolk CC

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