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Social care rates fall as hospital admissions rise

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Overall council performance on delayed transfers of care due to social care continued to improve as hospital admissions increased in December, despite more than half of local authorities failing to meet government targets set in July.

Analysis by Impower of NHS England data for December, released last Thursday, shows 84 of 151 councils (59%) missed the target for delayed bed days per 100,000 of the population set as part of the Better Care Fund (BCF) planning guidance.

However, overall delayed transfer days due to social care fell from 52,783 in November to 49,227 in December, at a time when hospital admissions were 3% higher than in December 2016.

The proportion of delays due to social care has fallen over the previous 12 months, from 36% in December 2016 to 33.9% in December 2017.

After the July target was set, 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 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 attributable to social care at a rate 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 analysis shows a total of 15 councils failed to meet these criteria, the same number as in the previous month.

Of the 15, eight councils are currently part a health and social care system operating above the government’s national target rate for delayed transfers of 9.6 and therefore considered at the most risk of some form of intervention.

The eight councils failing to meet government criteria and operating in health and social care system areas above the national target:

  • Bath & North East Somerset Council
  • Bristol City Council
  • Cambridgeshire CC
  • Leeds City Council
  • Norfolk CC
  • Nottingham City Council
  • Warrington MBC
  • York City Council

The December letter added that some councils were at risk of conditions being placed on 33% of improved better care fund allocations, with decisions being made last month based on the November data.

LGC understands no council has had conditions on funding to date, with all areas said to have agreed spending plans with NHS England.

Nottingham City Council’s portfolio holder for adults and health Nick McDonald (Lab) said the government had confirmed there would be no impact on its BCF allocation in 2018-19.

He added: “Like many areas around the country, we are facing demand for homecare that exceeds what is available.

“Referrals from the hospital have increased in winter while external homecare providers are unable to cope with the increased demand.

“This is a situation of the government’s own making as they have consistently failed to provide the appropriate level of funding for adult social care.”

A Bristol City Council spokesman said: “We have improved what we offer providers to make it more attractive for new organisations to work with us and will continue to make sure we can meet demand and reduce it wherever possible.”

Impower’s lead health director Sarah Atkinson said the latest delayed transfer figures are further evidence the £2bn extra funding allocated for social care in last year’s spring Budget is having an impact.

She added: “We are starting to see what looks like sustained improvement. But there are also a number of projects and schemes [to reduce delayed transfers] councils had not put in place until December, therefore there is more to come.”

However, Ms Atkinson warned emergency admissions to hospitals in January were 7% higher than they were in January 2016, which could impact on efforts to continue to reduce delayed transfers.

“We are concerned that if there is more demand in the system, at some point you stop being able to cope, or certainly improve performance,” she said.

Ms Atkinson said some struggling areas had been subject to “enforced support” with NHS England or NHS Improvement officials becoming involved in system-wide discussions. Some councils are being required to submit details and data on extra packages of care being put in place, she added.

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