Summary

Over the last year (March 2015-16) DToCs have increased considerably. For health the figures have increased, but for social care they have increased significantly.

Total figures

  • In March 2016, the number of delayed days were 169,928, for March 2015 there were 140,307 days. This represents a 21% increase over the last year. This is the highest number of total delayed days reported in a month since monthly data was first collected for August 2010.

Social care

  • In March 2015, the number of delayed days for social care reasons was 37,686. This rose to 54,763 in March 2016, which represents a 45% increase over the last year. (In February 2016 there were 50,686 days).

Health

  • In March 2016, the number of delayed days for health causes was 103,900 individual days, whereas, in March 2015 it was 91,491 which represents a 14% increase over the last year.

Both health and social care

  • In March 2015, there were 11,130 days which increased to 11,625 in March 2016. This represented a 4% increase.

Attributable to social care

  • 2% were attributable to social care in March 2016, which is up from 26.9% compared to March 2015. In February 2016, 32.2% of delays were attributable to social care. See attached document which shows further trends (tabs 3-4).

Peak

  • DToC has peaked for total, health and social care this month.

The next figures are due out on 9th June 2016 which will be for April 2016.

 

Reasons for the delay

  • Social care - The main reason for social care delays in March 2016 was patients awaiting care package in their own home. This accounted for 19,400 delayed days (35.4% of all social care delays), compared to 11,200 in March 2015.
  • For both health and social care there were 3,401 days delays due to awaiting completion of assessment.
  • Health - The main reason for NHS delays in March 2016 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 30,800 delayed days (29.6% of all NHS delays).

 

Trends over the last four years

Total

  • Over the last four years (March 2012 – March 2016) the total number of individual days has risen from 119,736 to 169,928. This represents a 42%
  • There have been particularly pressures over the last two years, in March 2014 there were 123,061 days.

Social Care

  • A similar trend for social care. Over the last three years (March 2013 - March 2016) the total number of individual days has risen from 31,980 to 54,763. This represents a 71% See attached document which shows further trends (tabs 1-2, 5-6).

Attributable to social care

  • 2% were attributable to social care in March 2016, which is up from 29.0% in March 2012. Historically over the last four 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 four years (March 2012 – March 2016) the total number of individual days has risen from 76,448 to 103,900. This represents a 36% increase.

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 will 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.

  • The funding that councils received for winter pressures in the last financial year was in no way proportionate to the scale of the task or the level of support needed for vulnerable people. Councils must be funded adequately if they are to continue reducing pressures and costs for NHS during times of increased demand. According to the ADASS Budget Survey, councils received only 5.9 per cent (£41 million) of the £700 million allocated to the NHS to respond to winter pressures in 2014/15. This money, even with the additional £37 million councils received directly to help tackle delayed transfers of care, was in no way proportionate to the scale of the task.
  • 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 – In early 2015, councils demonstrated the vital role they play in helping the NHS to manage seasonal demand pressures. 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. ADASS, the Care and Support Alliance, the Care Provider Alliance and the NHS Confederation have written to the Chancellor expressing concern that the funding is too little and too late. 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. Funding pressure on social care leave an unfunded pressure of at least £1.1bn by 2019/20 with a gap of at least £1.4bn in 2016/17 and of £1.6bn in 2017/18.

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.