Summary

Over the last year (April 2015-16) DToCs have increased considerably. For health the figures have increased, but for social care they have increased significantly. This follows a similar upward trend since April 2011, particularly over the last two years for social care.  

 

Total figures

  • In April 2016, the number of delayed days were 167,677 for April 2015 there were 138,011 days. This represents a 21% increase over the last year. This is the second highest number of total delayed days reported in a month since monthly data was first collected for August 2010. The previous highest was last month with 169,928 days.

 

Social care

  • In April 2015, the number of delayed days for social care reasons was 40,192. This rose to 55,125 in April 2016, which represents a 37% increase over the last year. (In March 2016 there were 54,763 days). These are the two highest months on record.

 

Health

  • In April 2016, the number of delayed days for health causes was 100,892 individual days, whereas, in April 2015 it was 87,181 which represents a 16% increase over the last year.

 

Both health and social care

  • In April 2015, there were 10,638 days which increased to 11,660 in April 2016. This represented a 10% increase.

 

Attributable to social care

  • 9% were attributable to social care in April 2016, which is up from 29.1% compared to April 2015. In March 2016, 32.2% of delays were attributable to social care. See attached document which shows further trends (tabs 3-4).

 

Peak

  • DToC peaked in March 2016 with 169,928 individual days and for social care in April 2016 with 55,125 days.

 

The next figures are due out on 14th July 2016 which will be for May 2016.

 

Reasons for the delay

  • Social care - The main reason for social care delays in April 2016 was patients awaiting care package in their own home. This accounted for 19,500 delayed days (35.3% of all social care delays), compared to 13,100 in April 2015.
  • For both health and social care there were 4,554 days to delays awaiting completion of an assessment.
  • Health - The main reason for NHS delays in April 2016 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 30,300 delayed days (30% of all NHS delays).

 

Trends over the last five years

Total

  • Over the last five years (April 2011 – April 2016) the total number of individual days has risen from 108,064 to 167,677. This represents a 55%
  • There have been particularly pressures over the last two years, in April 2014 there were 116,261 days.

 

Social Care

  • A similar trend for social care. Over the last five years (April 2011 - April 2016) the total number of individual days has risen from 34,335 to 55,125. This represents a 61% increase.
  • There have been particularly pressures over the last two years, April 2014 there were 28,978 days. There has been a 90% increase in delays over the last two years. See attached document which shows further trends (tabs 1-2, 5-6).

 

Attributable to social care

  • 9% were attributable to social care in April 2016. Historically over the last five years, the delays attributable to social care was mid-late twenties. However, over the last year this has risen to early thirties.

 

Health

  • Over the last five years (April 2011 – April 2016) the total number of individual days has risen from 66,304 to 100,892. This represents a 52% increase.
  • There have been particularly pressures over the last two years, April 2014 there were 79,280 days.

 

Key findings from ADASS survey about winter pressures carried out in late 2015:

  • 71% of DASSs routinely sign off DTOC returns.
  • 49% of councils have schemes designed to reduce winter pressures which have not yet had funding agreed locally.
  • The average value of these schemes without or yet to agree funding is £385,000.

 

Additional pressures

  • Over the last few months there have been a number of articles and comments about winter pressures. Nigel Edwards, chief executive, Nuffield Trust, said: “The issue of delayed transfers is fast becoming the biggest problem many NHS trusts are facing.”
  • The on-going junior doctor’s industrial action has put additional operational pressures on hospitals, and therefore we expect that acute trusts will want to be managing occupancy down as much as is safe and practically possible. An escalation process has been agreed between BMA and NHSE; if there is a significant incident in an area (e.g. road accident), the trust can inform NHSE if further support is needed at which point NHSE will approach the BMA. Directors of adult social care will continue contact with health colleagues through normal channels. As a key part of local discharge systems, social care services will continue to contribute to effective communication and coordination, particularly at times when there is extra pressure on NHS services and a need to proactively create more acute care capacity.
  • The Lord Carter report says that delays in discharging patients out of hospital could be costing the NHS £900m a year. Recent NICE social care guidelines called for better coordination of discharge planning between hospital and social care.

 

 Key messages 

  • DToCs have increased significantly, particularly for social services. ADASS has signalled the fragility of the social care market, the considerable workforce recruitment and retention issues and funding on many occasions. This is impacting on putting together packages of care for people to enable them to avoid hospital admission in the first place or to be supported home well after admission.
  • Knock on impact to patients, and health and social care - DToC can harm patients and create massive increased and avoidable costs for both the NHS and social services. Councils give a priority to helping people home from hospital even in these difficult financial times when fewer people are getting services. Work is underway to promote earlier discharge planning and increased use of reablement and intermediate care.
  • Role Council’s play in managing DToC – Councils prioritise hospital discharge and are engaged in a range of activities to help combat delayed transfers of care, such as through six and seven day working, reallocating social work capacity to hospitals to support discharge nurses, increasing reablement support services, commissioning additional ‘step-down’ care home beds to get people out of hospital, and purchasing additional home care capacity.
  • Challenges facing providers – From the ADASS Budget Survey, 56% of directors believe that providers are facing financial difficulties now (rising to 62% considering what the situation will be like in two years), fuelling wider concerns about provider viability and sustainability and the quality, quantity and duration of commissioned care. A proportion of providers are leaving the market or restricting supply to people who pay for their own care placing the most vulnerable at further risk.

 

Funding: Following the Spending Review the government claimed an above-inflation rise in care budgets by allowing local authorities to raise council tax by 2% for social care and increasing the amount of money available for the BCF. However, the BCF funding increase won’t happen for next year and only gradually increasing to funds of any significance at the end of the parliament. The £700 million in the BCF should be brought forward now to help address some of the financial challenges.

The Government’s own figures show that the potential benefit of the new 2% precept flexibility is £1.8 billion, not £2 billion as quoted by the chancellor.

The vast majority of councils have used the precept this year, but this might not be the case in the future. We estimate the funding gap for social care to reach £4.3 billion by 2020.

The Government will consult on whether the social care councils least able to raise additional funding through the precept should get a bigger proportion of the additional £1.5 billion to be allocated through the BCF. However, this may lead to some councils receiving no additional BCF money. Funding earmarked for implementation of the Care Act will be included in the baseline for calculating revenue support grant.

The full benefit of the new money will not be felt until the end of the decade, but services supporting older and disabled people to get safely home after hospital are at breaking point right now in many areas.