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Ministers consider funding cuts for delayed discharges laggards

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  • Poorly performing councils could see 2018-19 social care funding cut, says Jeremy Hunt
  • Hunt names 12 most ‘challenged’ councils which face a CQC review
  • Social care chiefs slam late ‘changes to guidance which undermine collective effort required’

Minsters are “considering” cutting funding for councils performing poorly against new metrics heavily weighted on delayed transfers of care performance, Jeremy Hunt has announced.

375_lgc_hsj_reporting

375_lgc_hsj_reporting

The health secretary also announced the Care Quality Commission will carry out quick fire reviews of the twelve most “challenged” areas, based on performance against the new “NHS-social care interface dashboard”.

Chris Hopson

Chris Hopson

Source: Neil O’Connor

Chris Hopson: ‘We are pleased there are now specific targets for each local authority’

They are: Oxfordshire, Birmingham, East Sussex, York, Coventry, Plymouth, Hartlepool, Bracknell Forest, Manchester, Halton, Trafford and Stoke-on-Trent.

The measures, set out in a ministerial statement last night (see box below), are part of a package of proposals aimed addressing the issue, which is caused by systemic problems across the NHS and social care system.

Mr Hunt said in a statement to media yesterday that councils “will set expectations on the contribution they must make to reducing” delayed transfers of care in their local areas, as reported by HSJ.

But he struck a more punitive tone in his statement to Parliament, stating that ministers could impose financial penalties on poor performers.

He said ministers were “considering a review, in November, of 2018-19 allocations of the social care funding provided at Spring Budget 2017 for areas that are poorly performing”. Any funding taken off areas will however “remain with local government, to be used for adult social care”, he added.

A Department of Health spokesman told HSJ the initiative would be a “joint effort” between the NHS and local government, but Association of Directors of Adult Social Services president Margaret Willcox revealed relationships were already under strain.

In repsonse to the announcement she said adult social care leaders were “very disappointed by the last minute unilateral changes to guidance that have taken place in the last few days. The consequence is to undermine the collective effort required”. The new rules are published more than three months into the current financial year, and follow on from a Better Care Fund policy framework published earlier in the year.

The “NHS-social care interface dashboard” is based on a number of metrics including Total Delayed Days per 100,000 population and the proportion of discharges (following emergency admissions) which occur at the weekend (see the dashboard here).

The move follows concerns raised by senior NHS figures, revealed by HSJ in May, that the extra £2bn of social care funding for councils in the Spring Budget would not relieve pressure on hospitals as ministers had hoped.

The government’s Mandate to the NHS for 2017-18 pledged delayed transfers of care should equate to no more than 3.5 per cent of all hospital beds by September, which would free up around 2,000 to 3,000 hospital beds.

However, NHS Providers’ research published last week said the proportion of beds occupied by DTOCs stood at 5.6 per cent at the end of 2016-17 – and only 18 per cent of trusts it surveyed were confident of hitting the September target.

NHS Providers chief executive Chris Hopson said it was “encouraging” ministers were attempting to address the issue. However, he added that NHS Providers’ warning “still stands” and he called for “£350m investment now to cope with pressures in the coming winter”.

Mr Hopson added: “We are pleased there are now specific targets for each local authority, which will be closely monitored. And we welcome the rapid CQC review of 12 areas to see how well they are working at the health and social care boundary. However we await detail of how this will work.”

CQC chief executive David Behan said: “Our intention is that the review findings will highlight what is working well and where there are opportunities for improving how the system works, enabling the sharing of good practice and identifying where additional support is needed to secure better outcomes for people using services.”

Key points from Mr Hunt’s DTOCs announcement:

  • The Integration and Better Care Fund Planning Requirements 2017-19, clarifying how this, and other aspects of the Better Care Fund Planning process, will operate
  • Joint NHS England, NHS Improvement, Local Government Association and Association of Directors of Adult Social Services guidance on implementing trusted assessors.
  • A performance dashboard showing how local areas in England are performing against metrics across the NHS-social care interface including delayed discharges
  • Plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds, including a breakdown of delayed days per 100,000 of the population and the indicative reduction levels required by each local authority and local NHS, which can be shared out differently at local level if agreed by both organisations
  • Considering a review, in November, of 2018-19 allocations of the social care funding provided at Spring Budget 2017 for areas that are poorly performing. This funding will all remain with local government, to be used for adult social care

 

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