Summary

Over the last year (November 2014-15) DToCs have increased considerably. For health the figures have slightly increased, but for social care they have increased significantly.    

 

Total figures

  • In November 2014, it was 140,949 individual days compared to November 2015, it was 153,200 individual days. This represents an increase of 9% over the last year, the same month by month comparison for October shows a 12% increase over the last year.
 

Health

  • In November 2014, the number of delayed days for health causes was 93,602 individual days, whereas, in November 2015 this was 95,124 which represents a 2% increase over the last year.
 

Social care

  • In November 2014, the number of delayed days for social care reasons was 37,610. This rose to 47,573 in November 2015, which represents a 26% increase. The same month by month comparison for October shows a 29% increase. (In October 2015 it was 49,413).
 

Both health and social care

  • In November 2014, there were 9,737 days which increased to 10,494 in November 2015.  This represented an 8% increase.
 

Attributable to social care

  • 31.1% were attributable to social care in November 2015, which is up from 26.7% compare to November 2014. For October 2015 30.9% of delays were attributable to social care. See attached document which shows further trends.
 

Peak

  • DToC peaked in October 2015 with 160,194 individual days. Also, the peak for social care was in October 2015 with 49,413 days.
 

The next figures are due out on 11th February 2016 which will be for December.

 

Reasons for the delay

  • Health - The main reason for NHS delays in November 2015 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 27,600 delayed days (29% of all NHS delays).
 
  • The other major reasons for delays are patient or family choice 18,367 days and awaiting completion of assessment 14,567 days.
 
  • Social care - The main reason for social care delays in November 2015 was patients awaiting care package in their own home. This accounted for 16,300 delayed days (34.2% of all social care delays), compared to 9,900 in November 2014.
  • Last month it was higher with 17,097 delayed days (34.6% of all social care delays).
  • The other major reasons for delays are awaiting residential home placement or availability 9,119 days, awaiting nursing home placement or availability 8,352 days and awaiting completion of assessment 7,805 days.
 
  • For both health and social care there were 3,264 days to delays in awaiting care package in own home, 3,146 days to delays awaiting attributable nursing placement or availability and 2,999 days awaiting completion of assessment.
 

Key findings from recent ADASS survey about Winter pressures:

  • 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 weeks health officials have warned that the flu season is under way, just as junior doctors go on strike, and 28 hospitals issue emergency warnings urging patients to stay away.

 

NHSE has undertaken an assurance process with all trusts in England, with reference to the strike, and around 70% had responded by 7 January.  So far, all are reporting that they will be able to cope but, should any issues emerge, arrangements are in place to inform local resilience fora through DCLG mechanisms.

 

The deepening crisis comes as Public Health England said latest data from across the country shows the flu season is now underway, with rising numbers of GP consultations and a near-doubling in admissions to intensive care because of influenza in one week.

 

Health officials have come under fire for stopping publication of key weekly data tracking A&E performance, and for banning hospitals from declaring major incidents if winter pressures jeopardise safety.

 

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.
 
  • Role Council’s play in managing DToC - Earlier last year 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 SR the government claimed an above-inflation rise in care budgets by allowing local authorities to raise council tax by 2% and increasing the amount of money available for the BCF, but not 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.
 

Our initial calculations show that, if all councils were to choose to use the precept (the right to increase council tax by an additional 2%) that could raise up to £1.6billion (the ‘almost £2billion’ quoted by Chancellor) over the life of the parliament. However, this is only £383million in the first year on its own and is short of meeting the funding gap of at least £700million per annum, which doesn’t include the NLW.

 

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.