Summary

Over the last year (June 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 June 2011, particularly over the last two years for social care.

Total figures

  • In June 2016, the number of delayed days were 171,298, for June 2015 there were 139,538 days. This represents a 23% 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 highest month was May 2016 with 171,452 days.

Social care

  • In June 2015, the number of delayed days for social care reasons was 43,727. This rose to 55,177 (second highest on record) in June 2016, which represents a 26% increase over the last year. (In May 2016 there were 56,041 days – highest on record).

Health

  • In June 2016, the number of delayed days for health causes was 102,559 (highest on record) individual days, whereas, in June 2015 it was 85,870 which represents a 19% increase over the last year. 

Both health and social care

  • In June 2015, there were 9,941 days which increased to 13,562 in June 2016. This represented a 36% increase.

Attributable to social care

  • 2% were attributable to social care in June 2016, which is up from 31.3% compared to June 2015. In May 2016, 32.7% of delays were attributable to social care. See attached document which shows further trends (tabs 3-4).

Peak

  • DToC peaked in May 2016 with 171,452 individual days and for social care in May 2016 with 56,041 days. June’s days are both just below these figures.

 

The next figures are due out on 8th September 2016 which will be for July 2016.

 

Reasons for the delay

  • Social care - The main reason for social care delays in June 2016 was patients awaiting care package in their own home. This accounted for 19,700 delayed days (35.7% of all social care delays), compared to 15,000 in June 2015.
  • For both health and social care there were 4,869 days attributable to awaiting completion of assessment.
  • Health - The main reason for NHS delays in June 2016 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 29,500 delayed days (28.8% of all NHS delays).

 

Trends over the last five years

 

Total

  • Over the last five years (June 2011 – June 2016) the total number of individual days has risen from 117,075 to 171,298. This represents a 46%
  • There have been particularly pressures over the last two years, in June 2014 there were 124,118 days.

Social Care

  • A similar trend for social care. Over the last five years (June 2011 - June 2016) the total number of individual days has risen from 37,593 to 55,177. This represents a 47% increase.
  • There have been particularly pressures over the last two years, June 2014 there were 30,599 days. There has been a 23% increase in delays over the last two years. See attached document which shows further trends (tabs 1-2, 5-6).

Attributable to social care

  • 2% were attributable to social care in June 2016, which is up from 24.7% in June 2014. 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 (June 2011 – June 2016) the total number of individual days has risen from 71,638 to 102,559. This represents a 43% increase.
  • There have been particularly pressures over the last two years, June 2014 there were 85,051 days.

Emergency admissions

  • There were 480,000 emergency admissions in the month, 4.7% higher than the same month last year.
  • Emergency admissions via type 1 A&E departments increased by 5.3% over the same period. (Type 1 - A large hospital department which provides a consultant-led, 24 hour service with full resuscitation facilities and designated accommodation for the reception of emergency patients).
  • The chart below shows the volume of emergency admissions per day in each month. Further statistical analysis can be found on the accompanying spreadsheet - tabs 7 and 10.

 

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. For example, the A&E Improvement Plans aim to help A&E waiting time performance. Support will be targeted at systems with the greatest need. System Resilience Groups should be transformed into Local A&E Delivery Boards. These will focus solely on urgent and emergency care. There are five interventions. The intervention of most relevance to SC is mandating ‘Discharge to Assess’ and ‘trusted assessor’ type models. This doesn’t mean social care paying and it isn’t mandatory.
  • Challenges facing providers – From the ADASS Budget Survey, four out of five directors believe that providers are facing financial difficulties now, there is continued evidence from our survey of actual failure within the provider market in the last 6 months, affecting at least 65% of councils and thousands of individuals as a consequence. This is 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. The BCF funding gradually increases during this Parliament, but only by any significance in 2019/20. 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. The new social care precept flexibility (used by 93% of councils) raised a total of £380m. This does, however, raise much more in some areas than others and raises least in areas with the greatest need for social care and local councils might not use the precept in the future. We estimate the funding gap for social care to reach £4.3 billion by 2020.

The Budget Survey showed cost pressures relating to the increased numbers of older and disabled people needing care and support continue to run at just below 3% per year. This equates to £413m additional pressure in 2016/17. To maintain care at the same level as last year would require more than an extra £1.1bn.

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.