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Exclusive: 'Undeliverable' DTOC reduction targets revealed

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More than a third of councils have been told to reduce delayed transfers of care from hospital attributable to social care by 50% or more by September, raising the possibility they could lose better care fund money if they fail.

A letter setting out DTOC reduction “expectations”, seen by LGC, was sent to council and NHS chief executives by the Department of Communities & Local Government and the Department of Health on 14 July.

Of the 152 councils with social care responsibility, 42 are required to reduce DTOCs by 60% or more based on their performance in February.

More than two thirds are expected to reduce average daily DTOCs by more than a third. However, 57 councils will hit their target if they maintain their February performance.

The letter accompanying the targets, signed by director general for local government at the DCLG Jo Farrar and DH director general for community care Jonathan Marron, said they would “take stock of progress” in November and “consider a review” of 2018-19 allocations of the £2bn additional better care fund cash announced for social care at the Budget. This could see poorly performing councils lose out on anticipated funding. 

The letter adds: “This funding will all remain with local government and will be used for adult social care but we will want to explore options that promote effective progress in reducing delayed transfers of care.”

But some council chiefs have raised concerns over the feasibility of the “indicative expectations” for DTOC reduction.

Northamptonshire CC has a requirement to reduce delayed transfers by 67%. Chief executive Paul Blantern said significant better care fund money had already been targeted at the interface between social care and hospitals.

But he said the government’s expectations were “entirely counterproductive” and the focus should be on outcomes rather than “arbitrary targets”.

He added: “If a fake undeliverable target is put onto the system that threatens the improved BCF funding in 2018-19 then of course those planned improvements would have to be withdrawn as soon as it was clear the false target was not going to be met, given our statutory duty to deliver a balanced budget.”

Norfolk CC chief executive Wendy Thomson, who leads the Norfolk and Waveney STP, said the council’s requirement to reduce delayed transfers by 42% was a “tough target”.

“We have decided not to escalate into a conflict but it is going to be tough,” she added.

Reading BC has been given the highest target of a 70% reduction, with a requirement to reduce average daily DTOCs from 10 in February to three in September. Figures for May show the council has reduced the DTOC rate to six.

Herefordshire and West Berkshire councils have been set a 69% target. 

The letter says there is an “immediate and significant challenge” to reduce delayed transfers ahead of winter and adds: “We are looking for your help to ensure that all local partners are tackling this immediate challenge in order to prevent people experiencing winter pressures similar to those seen last year in our health and care system.”

Earlier this month the government imposed a stronger requirement for the £2bn of extra social care funding, announced in the budget, to be spent on reducing delayed transfers of care from hospitals, including the possibility that funding would be removed from poorly performing councils.

This prompted the Local Government Association withdrew its support for Better Care Fund planning guidance for 2017-19, which states that councils must use their allocations to help meet a target to reduce delayed transfers of care to free up between 2,000 and 3,000 hospital beds across England.

A spokesperson for NHS England said: “Delayed transfers of care remain a significant barrier to improving patient care and freeing up more beds in our hospitals. Each Local Authority will need to agree their plan for meeting those goals in line with expectations set by government.”

*This story was updated on 28 July to inlcude a response from NHS England


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