Just under two-thirds of councils failed to meet the government target for delayed transfers of care attributable to social care in November, with the latest figures suggesting 11 are at the highest risk of losing control of some funding, research has found.
Analysis by Impower of NHS England data for November, released last Thursday, shows 89 of 151 councils (59%) missed their target for delayed bed days per 100,000 of the population.
These were set in July based on performance in February as part of the Better Care Fund planning guidance, which warned funding allocations from the £2bn announced in the Spring budget would be reviewed for councils deemed to be under-performing.
The Department of Health and the Department of Communities & Local Government, as they were known at the time, subsequently wrote to councils in December to say delayed transfers performance would be judged on five criteria.
The letter added that some councils were at risk of conditions being placed on 33% of 2018-19 improved better care fund allocations, with decisions being made this month based on the November data.
The criteria are: whether councils hit their targets in September 2017; whether performance had improved since the corresponding month in the previous year; whether performance had improved since February last year; and whether the council is in the bottom quartile for delayed transfer rates per 100,000 of the population. The letter also said areas would be judged on whether performance is below the government’s national target for delayed bed days rate attributable to social care of 2.6, which forms part of a target for reducing overall delayed transfer rates across the country, including those attributable to the NHS, to 9.4.
The November data reveals 15 councils failed to meet all of the above requirements. However, 11 of these councils are part of health and social care systems which were operating above the 9.4 national target for delayed transfers in February, and where overall performance had deteriorated by November, potentially placing them most at risk of losing control of some funding.
The 11 councils in systems operating above the national target are:
- Bath & North East Somerset Council
- Blackpool Council
- Bristol City Council
- Cheshire West and Chester Council
- Hampshire CC
- Leeds City Council
- Liverpool City Council
- Norfolk CC
- Nottingham City Council
- Warrington BC
- York City Council
According to Impower’s research, the health and social care system in Nottingham recorded the biggest rate of deterioration.
Hampshire CC leader Roy Perry (Con) said there are “significant challenges” in the county and confirmed the Care Quality Commission would carry out a local system review in the spring.
He added: “The locally validated DTOC figures agreed with system partners show reductions in the actual number of people delayed in the five acute hospitals that serve Hampshire in September, again in October and through November and December.”
A Liverpool City Council spokesperson said the city’s better care fund plan had been approved by NHS England last month and health secretary Jeremy Hunt had confirmed the funding allocation for 2018-19 would not be affected.
They added: “All our health partners recognise the size of the challenge of delays but we have continually shown significant improvements over the past seven years and are confident of continuing this trajectory.”
A Warrington BC spokesman said NHS England and DCLG had informed the council in December that conditions would not be placed on its social care funding.
They added: “It is our view that to attach any conditions to previously allocated funding at this stage would derail schemes agreed by all our system partners which are beginning to deliver some positive results for Warrington. We believe these same schemes will further alleviate pressures once they are more established.”
Impower’s lead health director Sarah Atkinson told LGC this month’s figures show a general “move in the right direction”, with a 22% overall improvement in delayed transfers since February and a “huge” 9% improvement this month in those attributable to social care.
But she added: “My issue is that I am not sure we are ever going to [hit the targets]. We still have a significant number of areas that still are not performing, and the trajectory is not in the right direction.
“On top of that we have got winter kicking in. There has been a massive increase in emergency admissions and that has to have an impact in terms of the back door of hospitals.”
The analysis found that six health and social care systems have reduced all delayed transfers of care by 60% or more since February. Salford recorded the biggest reduction of 79% and is now 31% below its target.