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Warning DTOC intervention could have 'dire' consequences

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The health secretary’s threat to take control of social care funding from councils deemed not to be sufficiently reducing delayed transfers of care could have “dire” consequences for vulnerable people, the Society of Local Authority Chief Executives & Senior Managers has warned.

Last week Health Service Journal revealed that Jeremy Hunt was set to write to around 30 councils and threaten to nationally direct how they use their share of the improved Better Care Fund next year, if they do not improve their performance on delayed transfers of care.

A separate but overlapping group of between 20-30 councils have been threatened with their funding being withheld this year, with the money potentially used directly by the NHS to buy care capacity.

Piali DasGupta

Piali DasGupta

Piali Das Gupta

Piali Das Gupta, head of policy at Solace, said such a move by the government would be “very disappointing” and “counter-productive” as it would “further destabilise the system”.

She said: “Councils have been clear that the consequences for vulnerable people would be dire should funding be withheld to meet unrealistic targets or if the rules about how the funding could be used were suddenly changed.”

Ms Das Gupta said the impact of the government’s “short-sighted” focus on delayed transfers of care was “worrying”.

She added: “At a time when councils and health partners are starting to make real progress toward operating as a system, we would urge central government not to seek to prop up one part of an overstretched system at the expense of the other. We need a sustainable funding settlement for health and social care as a whole.”

The letters are expected to say councils’ share of the improved better care fund – budgeted at £1.5bn in 2018-19 – would stay in their patch, but if they are judged as failing then the government may direct how it is spent.

It is unclear whether the letters will also be signed by a Department for Communities and Local Government minister.

The Local Government Association withdrew its support for the BCF planning guidance published in July. This introduced the possibility that councils could have social care funding withdrawn if they were judged to be performing badly against a series of metrics focused on the interface between health and social care.

Later that month NHS England issued delayed transfer of care targets to be achieved by each council by September, based on their performance in February. This meant more than a third of councils were required to reduce delayed transfers attributable to social care by 50% or more.

Last month more than half of West Midlands councils have rejected the “unachievable” targets and instead submitted trajectories to meet the targets over a longer period.

Health Service Journal also reported that ministers are planning to send a letter of congratulations to the councils judged to have made the required progress. This is said to be concerning some people in the NHS who fear social care related delays could still cause major problems even in these areas.


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