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Updated: Third of areas see DTOC deterioration

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Delayed transfer of care rates in just over a third of area are off target and deteriorating, new figures show.

*The DTOC rates in this story were previously wrongly presented as those attributable to social care alone when in fact they relate to overall DTOC performance of NHS and local government in an area. The story has been amended to reflect that. LGC apologises for any confusion caused.

Despite a 5% improvement in rates of delayed transfer of care attributable to social care in October compared to the previous month, analysis by Impower of NHS England’s delayed transfers figures for the month shows that when NHS and local government performance is taken together 103 of 151 council areas are still missing their targets.

The targets were outlined in the Better Care Fund guidance published in July and were set using a baseline of performance on both social care and NHS organisations in February

Areas that had a delayed transfers rate of 9.4 bed days per 100,000 of the population or above in February are required to hit the 9.4 rate, while those achieving a lower rate in February are required to maintain their performance at that level.

Of the areas that missed their target in October, 54 saw an increase in their DTOC rate. However, the remainder improved their performance with more than a third less than two points off hitting their target. The remaining 48 areas have hit their target and continue to improve.

Of the worst performing areas – those missing the target and continuing to deteriorate - Hampshire missed its target by the biggest margin in October (18.4 bed days lost per 100,000 population), followed by Bury (18.1).

Calderdale has seen the largest rise in delayed transfers since February at 335% followed by Greenwich at 166%. Both are missing their targets.

Of the best performing areas, Gateshead had a DTOC rate 6.5 lost bed days below its target in October, with a fall in delayed transfers of 71% since February. Isle of Wight and Salford also achieved 71% decreases.

Councils’ performance in reducing delayed transfers attributable to social care could influence next year’s allocation of the additional social care funding announced at the March Budget. As LGC reported last month, performance in September will be used to determine the allocations in the provisional local government finance settlement.

These allocations will then be updated in the final settlement to reflect performance in November, data on which will become available in January.

Impower’s lead health director Sarah Atkinson said some councils performing poorly on delayed transfers attributable to social care are in discussions with the Department of Health and Department of Communities & Local Government over whether they can “be allowed” to spend their improved better care fund allocation in 2018-19 without conditions attached.

But she added that there has been recent continual month-on-month progress on social care delayed transfer rates, with a 6% improvement in September and a 5% reduction in October.

Ms Atkinson added: “We may well be beginning to see the impact of the improved better care fund money but our concern is we are about to enter the winter, which puts more pressure on hospital services, so the next couple of months will be critical to see whether we have broken through.”

She said that the government was likely to permanently impose delayed transfer targets on councils despite social care delayed transfers improving at five times the rate of those attributable to the NHSMs Atkinson added: “We are still concerned because what that means is it is going to take 12 months [at the current rate of reductions] to hit the government’s expectations around delayed transfers of care, which I don’t think will be an acceptable trajectory.“We will still feel the heat in the sector to improve performance and pressure with the next round of CQC inspections.”

 

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