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'DToC targets mean more decisions are made at a time of crisis'

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It’s the acronym that haunts social care and the NHS – DToC.

Delayed transfers of care are a continuing challenge in Norfolk and, despite stronger than ever planning for winter, it has remained stubbornly high.

In close partnership with our NHS colleagues, we bought more care, expanded reablement, gave above inflation uplifts to providers for the third year running, strengthened our arrangements with care homes, and increased our number of social workers and occupational therapists.

“We have analysed the numbers and had several full and frank exchanges of views”

Despite this, DToC has remained stubbornly high, and adult social services remains a long way off its target.

We’ve chased down different lines of inquiry and made interventions in one part of the journey, only for another issue to emerge somewhere else. We have analysed the numbers and had several full and frank exchanges of views about their attribution. But now the hard work really begins; we believe that a sustained turn-around will come only through a renewed, whole-system approach.

Every £1 spent in Norfolk on reablement delivers a return of £4. Last year, over 8,000 people benefited from up to six weeks of reablement, regaining their independence and control over their lives.

The focus is now shifting to truly embed home first and discharge to assess, which is potentially transformative.

Our health and social care landscape is complex, with 13 separate autonomous organisations involved in some stage of a person’s journey through the system. We have a large, predominately rural county to cover, with a growing frail population, where dementia is becoming an increasing and urgent challenge. It is expected that 25% of the population will be 65+ by 2022, with a significant increase in the 85+ population.

Our strategy for a sustainable future is ’promoting independence’, focusing on a ‘shift-left’ approach which sees investment in community services and prevention, leading to less reliance on residential and nursing care.

This is challenging when the sheer volume of people through our system remains high, and the main measure focuses on delays. As in other areas, the unintended consequence is more admissions to short-term or long-term residential care, based on decisions made at a time of crisis, which then turn into permanent residential care.

We audited cases to see whether there could have been alternatives to residential care; the findings showed that at that point in the individual’s life, the permanent care was the option that best met their needs – but looking further back we believe there was earlier support which could have meant a different outcome.

The DToC measure and target has undoubtedly concentrated minds and brought about improvements. In Norfolk, we are far from complacent and will continue day-in, day-out to make any marginal gains we can, while embracing whole-system change which helps people stay independent in their own homes.

James Bullion, executive director of adult social services, Norfolk CC

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